Howard County General Hospital Community Health Needs ... · 30.06.2016 · The action plan...

Howard County General Hospital

Community Health Needs Assessment and

Implementation Strategy

June 30, 2016


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TABLE OF CONTENTS

CONTENTS PAGE

I. Introduction .............................................................................................................................. 1

II. Service Area and Population

a. Overview ....................................................................................................................... 2

b. The Community We Serve ............................................................................................ 3

III. Approach and Methodology

a. Primary Data ................................................................................................................. 7

b. Secondary Data ............................................................................................................. 8

c. Local Health Improvement Coalition ............................................................................ 9

d. Health Experts ............................................................................................................... 9

IV. Key Community Priorities

a. Access to Affordable Care ........................................................................................... 11

b. Behavioral Health ........................................................................................................ 11

c. Healthy Aging .............................................................................................................. 12

d. Healthy Weight, Exercise and Nutrition ...................................................................... 12

e. Other Identified Needs ............................................................................................... 12

V. Implementation Strategy ........................................................................................................ 13

Appendices

Appendix A: Community Resource Inventory .............................................................................. 20

Appendix B: Howard County Health Assessment Survey, 2014 .................................................... 23


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I. Introduction With the enactment of the Patient Protection and Affordable Care Act (PPACA) on March 23, 2010, tax-exempt hospitals require community health needs assessments (CHNA) and implementation strategies, which are approaches and plans to actively improve the health of communities served by health systems. These strategies provide hospitals and health systems with the information they need to deliver community benefits that can be targeted to address the specific needs of their communities. Coordination and management strategies, based upon the outcomes of a CHNA and implementing strategies, can improve the impact of hospital community benefits.

To adhere to the requirements imposed by the IRS, tax-exempt hospitals and health systems must:

• Conduct a CHNA every three years.

• Adopt an implementation strategy to meet the community health needs identified through the assessment.

• Report how it is addressing the needs identified in the CHNA and a description of needs that are not being addressed, with the reasons why.

The Department of the Treasury and the IRS require a CHNA to include:

1. A description of the community served by the hospital facility and how the description was determined.

2. A description of the process and methods used to conduct the assessment.

• A description of the sources and dates of the data and other information used in the assessment and the analytical methods applied to identify community health needs.

• A description of information gaps that impact the hospital organization’s ability to assess the health needs of the community served by the hospital facility.

• Identification of organizations that collaborated with the hospital/health system and an explanation of their qualifications.

3. A description of how the hospital took into account input from persons who represent the broad interests of the community served by the hospital. In addition, the report must identify any individual providing input that has special knowledge of or expertise in public health. The report must also identify any individual providing input who is a “leader” or “representative” of populations.

4. A prioritized description of all of the community health needs identified through the CHNA, as well as a description of the process and criteria used in prioritizing such health needs.

5. A description of the existing health care facilities and other resources within the community available to meet the community health needs identified through the CHNA.


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6. A description of the needs identified that the hospital intends to address, the reasons those needs were selected, and the means by which the hospital will undertake to address the selected needs.

The 2016 CHNA process for Howard County General Hospital (HCGH) included the collection and analysis of primary and secondary data. Both public and private organizations, such as faith-based organizations, government agencies, educational systems and health and human services entities were engaged to assess the needs of the community.

Primary data, gathered from more than 2,000 participants via an extensive phone survey in the Howard County Health Assessment Survey (HCHAS) and completed in 2014 was used for this report. Through interaction with a broad array of Howard County stakeholders, the survey results assessed health related behaviors and risk factors among the adult population in Howard County.

Secondary data from local, state and federal sources provided essential information, insight and knowledge on a broad range of health and social issues and a resource inventory was compiled to assess the availability of services to residents in Howard County. Collecting and examining information about different community aspects and behaviors help explain and identify factors that influence the community’s health.

The action plan developed for the county by the Local Health Improvement Coalition (LHIC) guided the creation of the Implementation Strategy for HCGH.

More information on data gathering and analysis is included in section III. This report is a summary of primary and secondary data collected throughout the CHNA, the methodology used, the resulting identified key prioritized needs and an action plan (Implementation Strategy) addressing those needs.

II. Community Benefit Service Area

The Hospital defines its Community Benefit Service Area (CBSA) using the twenty-five ZIP codes contained within the geographic boundaries of the Howard County jurisdiction as set forth by the Maryland Department of Planning and Zoning. U.S. Census-designated cities (CDP) within the boundaries of Howard County include Columbia, Ellicott City, Elkridge, Jessup, and Savage. The combination of HCGH’s status as the only acute care hospital in Howard County and the natural boundaries of the Patapsco and Patuxent rivers provide a level of “containment” of the local population for seeking health care and other services. In FY 2015, of HCGH’s total patient discharges approximately 68% (13,587 of 19,969) resided in the CBSA1, further supporting the definition of the Howard County jurisdiction as the Hospital’s CBSA. Map 1 below highlights the CBSA.

1 HSCRC and Johns Hopkins Medicine Business Planning and Market Analysis, 2015


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Map 1: Overall Community Benefit Service Area – 2015 Study Area Map

Howard County Zip Codes: 20701, 20723, 20759, 20763, 20777, 20794, 20833, 21029, 21036, 21042, 21043, 21044, 21045, 21046, 21075, 21076, 21104, 21163, 21723, 21737, 21738, 21771, 21784, 21794, 21797 Howard County is an affluent, educated and healthy community inhabited by 307,260 residents. Demographic projections estimate that the County will increase in population, as well as age overall, growing and graying. Between 2010 and 2035, the overall population is estimated to increase by 26.6%. During the same time period, those ages 50 and older will increase by 60.7%, which is more than double the aging rate for the total county population. An estimated 38% of county residents will be 50 or older by 2035. 2 This will be of particular importance as this population will be more likely to develop chronic diseases and potentially consume more health dollars. Howard County is also a diverse community, with higher rates of foreign born residents as compared to the state overall (18.2% versus 14%) and higher rates of languages other than English spoken in the home as compared to the rest of Maryland (22.5% versus 16%).

2 Maryland Department of Planning population projections, 2013.


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Tables 1-5 below offer snapshots of key county demographics, including population breakdowns by sex, age, race and ethnicity, educational attainment, and household income for Howard County, the Columbia census-designated place (which accounts for nearly a third of County residents), Maryland, and the nation. Based on the population demographics below, it is notable that Howard County has higher educational attainment and higher household income than compared to Maryland as a whole. Also, the racial/ethnic makeup of Howard County differs from Maryland in that the percentage of the population that is Black/African American is lower than for Maryland, whereas the percentage of the population that is Asian & Pacific Islander is higher than for Maryland. The Columbia CDP, however, has higher African American and Hispanic residence and lower Asian & Pacific Islander residence, respectively, than the County as a whole. Table 1. Population by Sex, Howard County

2015 Projected 2020 Total Male Population 152,265 (49.5%) 162,515 (49.5%)

Total Female Population 154,995 (50.4%) 165,807 (50.5%)

Source: Truven Health Analytics, 2015 Table 2. Population by Age

Age

Howard County

Columbia CDP

Maryland

USA

0-14 58,081 (18.9%) 19.5% 18.9% 19.1% 15-17 13,708 (4.5%) 3.8% 4% 4% 18-24 27,536 (9%) 7.8% 9.6% 9.9% 25-34 37,848 (12.3%) 15.2% 13.6% 13.3% 35-54 92,308 (30%) 28% 28.4% 26.3% 55-64 40,611 (13.2%) 12.5% 12.5% 12.7% 65+ 37,168 (12.1%) 12.2% 13% 14.7%

Source: Truven Health Analytics, 2015 and American Community Survey, 2015


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Table 3. Race/Ethnicity

Howard County Columbia CDP

Maryland USA

White-Non-Hispanic 168,266 (54.8%)

50.1% 53.6% 61.8%

Black Non-Hispanic 57,401 (18.7%) 25.2% 29% 12.3%

Hispanic 20,628 (6.7%) 8.4% 8.8% 17.6% Asian & Pacific Is. Non-Hispanic

49,454 (16.1%) 12.3% 5.8% 5.3%

All Others 11,511 (3.7%) 3.5% 2.8% 3.1% Source: Truven Health Analytics, 2015 and American Community Survey, 2015 Table 4. Education Attainment Age 25 or More


Maryland USA

Less than High School 4,601 (2.2%) 2.8% 4.3% 5.9%

Some High School 6,019 (2.9%) 2.3% 6.7% 8%

High School Degree 30,712 (14.8%) 11.7% 25.7% 28.1%

Some College 43,839 (21.1%) 20.3% 25.9% 29.1% Bachelors Degree or Greater

122,764 (59%) 62.8% 37.3% 28.9%

Source: Truven Health Analytics, 2015 and American Community Survey, 2015 Table 5. Household Income


Maryland USA

<$15,000 4,672 (4.2%) 5.5% 8.5% 12.7% $15-25,000 3,544 (3.2%) 3.5% 6.9% 10.8% $25-50,000 11,701 (10.5%) 12.6% 18% 23.9% $50-75,000 14,080 (12.7%) 14.4% 17.2% 17.8% $75-100,000 14,435 (13.0%) 13.8% 13.4% 12% Over $100,000 62,705 (56.4%) 50.1% 36.1% 22.8%

Source: Truven Health Analytics, 2015 and American Community Survey, 2015 Howard County is one of the healthiest counties in the state of Maryland as determined by the County Health Rankings website (www.countyhealthrankings.org) that is supported by the Robert Wood Johnson Foundation and hosted by the University of Wisconsin Population Health Institute. Of note, Howard County has a lower percentage than Maryland averages, and even top national counties, in measures such as the adult smoking rate (8% versus 15% Maryland and 14% national), adult obesity (23% versus 28% Maryland and 25% national), teen births (11 per 1,000 females


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ages 15-19 versus 29 Maryland and 20 national), premature death (3,842 years of potential life lost before 75 per 100,000 versus 6,459 Maryland and 5,200 national), and uninsured population (7% versus 12% Maryland and 11% national). Conversely, the County exceeds the average rate in other counties nationwide in indicators such as low birthweight babies (8% versus 5.9%), excessive drinking (15% versus 10%), and alcohol-impaired driving deaths (38% vs. 14%). See Table 6 below for additional details. Table 6. County Health Rankings 2015 – Howard County

Howard County

Error Margin

Top U.S. Performers

Maryland

Health Outcomes Length of Life Premature death 3,842 3,576-4,108 5,200 6,459 Quality of Life Poor or fair health 9% 8-10% 10% 13% Poor physical health days 2.4 2.1-2.7 2.5 3 Poor mental health days 2.5 2.2-2.8 2.3 3.2 Low birthweight babies 8% 7.7-8.4% 5.9% 9%

Health Factors Health Behaviors Adult smoking 8% 7-10% 14% 15% Adult obesity 23% 21-26% 25% 28% Food environment index 9.3 n/a 8.4 8.2 Physical inactivity 18% 16-20% 20% 23% Access to exercise opportunities

98% n/a 92% 94%

Excessive drinking 15% 14-18% 10% 15% Alcohol-impaired driving deaths

38% n/a 14% 34%

Sexually transmitted infections 164 n/a 138 451 Teen births 11 10 to 12 20 29 Clinical Care Uninsured 7% 6-8% 11% 12% Primary care physicians 511:1 n/a 1,045:1 1,131:1 Dentists 1,248:1 n/a 1,377:1 1,392:1 Mental health providers 412:1 n/a 386:1 501:1 Preventable hospital stays 41 38-43 41 54 Diabetic monitoring 88% 84-91% 90% 84% Mammography screening 66.3% 62.9-69.6% 70.7% 64.6%


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Howard County

Error Margin

Top U.S. Performers

Maryland

Social & Economic Factors High school graduation 90% n/a 93% 83% Some college 84% 81.7-86.3% 71% 67.5% Unemployment 4.9% n/a 4.0% 6.6% Children in poverty 7% 5-8% 13% 14% Income inequality 3.6 3.5-3.7 3.7 4.5 Children in single-parent households

22% 20-23% 20% 34%

Social associations 8.7 n/a 22 9 Violent crime 201 n/a 59 506 Injury deaths 33 30-36 50 54 Physical Environment Air pollution - particulate matter

12.7 n/a 9.5 12.5

Drinking water violations 0% n/a 0% 16% Severe housing problems 13% 12-14% 9% 17% Driving alone to work 81% 80-82% 71% 73% Long commute - driving alone 46% 44-47% 15% 47%

III. Approach and Methodology

The CHNA process for Howard County General Hospital included the collection and analysis of primary and secondary data. Members of public and private organizations, such as faith-based organizations, government agencies, educational systems and health and human services entities provided their assessment of the needs of the community. The 2014 CHNA served as a baseline to provide a deeper understanding of the health and socioeconomic needs of the community.

Primary Data

The 2014 Howard County Health Assessment Survey (HCHAS) was used for this CHNA. It is a biennial study first administered in 2012. Reaching more than 2,000 participants via a telephone survey it provided a wealth of direct information that would not have been attainable through individual hospital resources. The survey was jointly commissioned by the Horizon Foundation, the Howard County Health Department, Howard County General Hospital, and the Columbia Association. OpinionWorks, LLC provided the technical aspects of the survey, including recommendations on the precise wording of questions, population sampling, and telephone data collection. The fact sheets and website were developed by Simplicity Metrics. The organizations sponsoring the HCHAS jointly determined the questions that were asked. The survey approach, methodology, and questions were modeled after the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System (BRFSS). This means that residents across the country have been asked many of the same questions and results from national studies may be effectively


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compared with Howard County results. Additional questions were added to the 2014 survey to gain more detailed information in certain areas.

The survey assessed health-related behaviors and risk factors among the adult population of Howard County, Maryland. Results of this study have enabled local government, health providers and stakeholders to measure progress and determine where to focus resources for improved health outcomes particularly focused on reduction of health disparities. More than 2,000 residents participated in the phone survey between July 8 and August 18, 2014. In order to be compared geographically, the county was divided into five sampling areas, based on the seven regional planning areas, with the three westernmost planning areas combined into a single sampling area. Howard County households were dialed at random, and the first adult to answer the phone was asked to participate in the survey. Caregivers were not allowed to answer for others; answers for all study respondents reflected their own characteristics and experience. The survey was administered in English and in Spanish.

As is common with telephone surveys, some populations were underrepresented (including African Americans and residents ages 18 to 34), while other groups were overrepresented (including whites, women, and residents over age 65). To ensure the survey results reflected the characteristics of the county, a statistical procedure known as weighting was used. The demographic profile of the survey was adjusted to be similar to the actual population, based on the most recent U.S. Census data. In short, the answers from those groups underrepresented in the sample count more when totaling up responses and calculating averages to accurately represent all residents.

Secondary Data

Information collected from secondary data provided essential information, insight and knowledge on a broad range of health and social issues. Data collected encompassed socioeconomic information, health statistics, demographics, children’s health, mental health issues, etc. The data sources included demographic information from Truven Health Analytics and the U.S. Census and reports and websites of local, state, and federal agencies, such as the U.S. Census American Community Survey, County Health Rankings, Maryland State Health Improvement Process (SHIP), and Howard Health Counts.

Resource Inventory

Howard County has many resources that contribute to its being identified as one of the healthiest counties in Maryland, according to the 2015 County Health Rankings. The location of the county is a perfect suburban location between Baltimore, MD and Washington, D.C. The high income level (more than 50% of households earn more than $100,000/yr), high rate of advanced education of residents (close to 60% have a college education or advanced degree) and a high rate of insured residents (97%) add greatly to the overall health of the community.


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A resource inventory was created to identify services available within the HCGH community area to assess any gaps in care. The inventory identifies organizations and agencies in the community that are serving the various target populations within each of the priority needs. The resource inventory appears in Appendix A.

Local Health Improvement Coalition (LHIC)

The Local Health Improvement Coalition (LHIC), a part of the State Health Improvement Plan (SHIP), was formed in 2012 and is responsible for guiding local health planning, specifically as it relates to addressing health disparities and inequities in the local community. After almost four years of combined efforts, focused interventions have occurred, groups are working more cohesively and expectations of improved outcomes are anticipated over time. In order to ensure broad based input of the community served by the Hospital, the LHIC, led by the HCGH President, Steven Snelgrove and the Howard County Health Officer, Maura Rossman, M.D., served as the task force for identifying and prioritizing the highest needs of the community in Howard County. The task force included leaders of local health and human service organizations, county government leadership, local business leaders and hospital leaders who provided input through their participation in this process.

Health Experts

The health experts for the August 2014 health survey were members of the Howard County Survey Planning Committee. LHIC membership also provided input during monthly meetings. Examples of the collaborative efforts between health experts appear in the Table 7 below. Table 7. Howard County Survey Planning Committee

Organization Key Collaborator and Title Collaboration Description LHIC Maura Rossman, M.D., Health

Officer and LHIC co-chair Steve Snelgrove, HCGH President and LHIC co-chair Jeananne Sciabarra, LHIC Director

More than 40 member organizations voted to determine the health priorities for calendar years 2015-2017 in November 2014.

Howard County Health Department

Maura Rossman, M.D. , Health Officer Felicia Pailen, Dir., Policy and Planning Jacqueline Douge, M.D., Director Child Health Kati Moore, Health Policy Analyst

Staff provided input on questions of interest for the survey that were reflective of community health needs. Assistance was given in the outreach to the community about the survey as well as a point of contact for the data analysis.

Columbia Association Shawni Paraska, Dir., Community Health Sustainability

Provided input on questions concerning healthy behaviors and physical activity.


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Horizon Foundation Glenn Schneider, Chief Program Officer Au’Sha Washington, Research Associate Tiffany Callender, Sr. Program Officer

Provided coordination of the survey process, input into pertinent questions for the survey and agency contact for the consultant group performing the survey.

Johns Hopkins Medicine Howard County General Hospital

Steve Arenberg, Dir. Marketing Research, JHM Elizabeth Edsall Kromm, Sr. Dir., Population Health and Community Relations Cindi Miller, Dir. Community Health Education, HCGH

Provided advice on marketing research. Provided input on HCGH Community Health Needs.

OpinionWorks, LLC Steve Rabe, President Provided expertise in survey question development, data collection and data summary.

Prioritization

The LHIC served as the focus group and task force for the final determination of key priorities. Howard County General Hospital, a member of this group, contributed to the prioritization. All priorities were also to consider the following criteria:

• The level of disparities related to the health outcome. • How improvement would affect large populations. • How improvement can improve several health outcomes. • The opportunity to control high cost and long-term impact while addressing

the issue. • How results could be quantified.

For the 2015 HCGH CHNA, the LHIC Membership provided recommendations and support for the ongoing health priorities. They are local stakeholders with an active interest in health improvement and they are qualified to review current health status information and establish shared health improvement priorities. They represent diverse and important populations in Howard County.


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IV. Key Community Priorities

The top priority needs were identified as: 1. Access to Affordable Care 2. Behavioral Health 3. Healthy Aging 4. Healthy Weight, (Exercise and Nutrition)

These areas were consistent with the four areas voted as health priorities by HCGH in their first CHNA in 2012. They are also the four identified LHIC priorities for 2015-2017. Chronic disease is considered to be incorporated into the four prioritized needs, as it is believed that by addressing these targeted areas there will be improvements in chronic diseases and conditions. All four priority areas are interconnected with the prevalence of chronic disease and a major factor impacting healthy aging. An example of how chronic disease is addressed within healthy aging is through interventions such as referrals to the Community Care Team (CCT) at the time of hospital discharge. The CCT will address greater compliance of the discharge plan, thus allowing for greater control of chronic disease. The HCHAS results confirmed that Howard County is, on average, healthier than the rest of the country, but significant health challenges persist—especially among those with lower levels of income and education, as well as health outcomes related to everyday choices about smoking, drinking, diet, and exercise. Also, disparities still existed in access to care, with more than 10% of African Americans not having health insurance. Healthy weight improvement was very slight, and there were small changes in Emergency Department visits for behavioral health conditions. Please see Appendix B for the 2014 HCHAS report of findings, including a copy of the survey instrument. Access to Care

The survey revealed that 15,229 residents currently do not have health insurance coverage. This number has decreased by about 2,700 since 2012. However, problems of inequality compared by income, race and education still remain. While 95% of residents have some type of health care coverage, only 88% of respondents in households making less than $50,000 a year have coverage, and only 88% of those with a high school diploma or GED have coverage.

Respondents who identified their race as African American, Hispanic, or Native American/Other were more likely to experience health access difficulties. While 96% of White residents said they have health coverage, only 90% of African Americans, 90% of Hispanics, and 90% of those in the Native American/Other category report having coverage. Employment status also affected access to health care. For example, while 96% of those employed say they have some type of health insurance, only 90% of those who were self-employed and 78% of those unemployed were insured. Behavioral Health

Women were more likely than men to report taking medication or receiving treatment from a doctor or other health professional for a mental or emotional condition (9% vs. 5%). Between


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2012 and 2014, about the same percentage of residents reported being stressed about money for vital expenses, such as rent, mortgage, and food. However, respondents who identified their race as African American, Hispanic, or Native American/Other were more likely to experience this type of stress. 53% of White residents said they were never stressed about money for vital expenses, compared with 42% of African Americans, 28% of Hispanics, and 38% of those in the Native American/Other category.

Additionally, there was a noticeable increase in residents aged 18 to 34 who reported binge drinking or having more than five drinks for men and four drinks for women, at least once in a month. In 2012, 20% of residents in this age group reported binge drinking at least once in a month, and in 2014 that percentage increased to 27%. Healthy Aging The population of older adults is growing, and this group is at high risk for developing chronic disease. Between 2012 and 2014 the same percentage of residents aged 50 – 64 reported having high blood pressure (35%), diabetes (10%) and COPD or another breathing condition (4%). This same age group reported a decrease in cholesterol (47% to 44%). Residents aged 65 and older had increases in high blood pressure (59% to 61%), cholesterol (50% to 56%) and diabetes (20% to 24%). Seniors 65+ reported a decrease in COPD or other breathing condition (9% to 6%). Continued efforts to decrease aspects of chronic disease by encouraging lifestyle changes of medication compliance, healthy eating and physical activity will support reduction in these above measurements. Healthy Weight (Exercise and Nutrition)

56% percent of Howard County respondents reported BMI scores in the overweight or obese range, compared with 64% of Marylanders. Although fewer Howard County residents were overweight or obese compared to the State, many survey participants reported behaviors that contribute to unhealthy weight, including lack of exercise and low consumption of fruits and vegetables. When broken down by race, there were decreases in overweight/obesity rates among all races/ethnicities from 2012 to 2014, except a slight increase among White residents (55% to 59%) and a strong increase among Hispanic residents (39% to 53%). Additionally, residents earning less than $50,000 are getting more than 1 serving of fruit per day in 2014 (64%) compared to 2012 (46%). Other Needs

HCGH is a comprehensive, acute-care medical center with 266 licensed beds specializing in women`s and children’s services, surgery, cardiology, oncology, orthopedics, psychiatry, emergency services, outpatient therapy and services and community health education. To support the diverse health needs of the community, the hospital’s professional staff is comprised of more than 900 physicians and allied health professionals, representing nearly 100 specialties and subspecialties. Although the four identified needs in this 2016 CHNA do not encompass all health needs of the community, HCGH has a full community health and wellness program addressing many needs


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including those not specifically discussed here. More information can be found in the FY2015 Community Benefit Report (CBR) which can found online at: http://www.hopkinsmedicine.org/the_johns_hopkins_hospital/about/in_the_community/community_benefits.html. The hospital’s Wellness Center conducts over 500 classes, screenings and educational events addressing a full spectrum of community health needs. A few examples of programs and initiatives that are active at HCGH that address needs outside of the assessment key priorities are included in Table 8 below. Table 8: Hospital Programs/Activities that Support Other Key Health Needs

Health Need Program and Description Partners Infant Mortality/ Low Birth Weight

Healthy Families Howard County - Counseling and support for at-risk first time parents Early Prenatal Education classes - Free classes to focus on health for mom and infant. Breastfeeding Classes and support group - Promotes Breastfeeding as the best option for infants.

Family And Children’s Services Local Children’s Board Howard County Health Department

Hypertension Regular Hypertension Screenings as well as ongoing health information and educational programming CPR Across Howard County - Annual event to teach Free Friends and Family CPR

20 diverse faith communities throughout Howard County Howard County Office on Aging – 50+ Centers American Heart Association Howard County Fire Department

Smoking Smoking Cessation Classes Howard County Health Department

Diabetes Pre-Diabetes Classes Diabetes management classes Free Glucose Screenings

Howard County Office on Aging

V. Implementation Strategy

HCGH will continue to prioritize activities linked to our four community health needs priority areas and will monitor and evaluate progress made over the next three years. With a commitment to two additional cycles of the health assessment survey in 2016 and 2018, there will be close tracking of data to assess outcomes. HCGH’s commitment to improving the health of its community will be evident through deliberate collaborations targeting specific segments of our community experiencing gaps in any of the four priority health areas and providing in-kind

http://www.hopkinsmedicine.org/the_johns_hopkins_hospital/about/in_the_community/community_benefits.html

http://www.hopkinsmedicine.org/the_johns_hopkins_hospital/about/in_the_community/community_benefits.html


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and financial support to organizations and initiatives that share our commitment to addressing these priorities. HCGH’s Board of Trustees and executive leadership will ensure the Hospital’s strategic and clinical goals are aligned with the four community health improvement initiatives. The implementation plan focuses on close alliances with organizations who have common goals and are key stakeholders. Collaboration yields the potential for enhanced outcomes and efficiency of resources. Most are also active member of the LHIC and are already committed to building a healthier Howard County community. Implementation Strategy Action Items appear below.


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Community Health Need Priority Area – Access to Care

Goal Strategies Metrics Partners Increase access to care for Howard County residents.

• Provide informational programs on Medicare and educate residents on importance of having a medical home

• Number of sessions held • Number of participants

• Howard County Department of Citizen Services- Office on Aging

• Maryland Access Point • Maryland Senior Health

Insurance Program (SHIP) • Participate in school-based

telemedicine program for children in title I elementary schools

• Provide consultations for children who are uninsured or do not have regular access to a pediatrician

• Number of children served • Howard County Health Department

• Howard County Public School System

• Provide health screenings and connection to community resources to improve access to care for Hispanic population

• Increase number of attendees to Latino Health Fair (organized and administered by HCGH)

• St. John’s Catholic Church • FIRN • Priority Partners (Medicaid

MCO) • Howard County Health

Department


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Community Health Need Priority Area – Behavioral Health Goal Strategies Metrics Partners

Increase timely access to behavioral health services for residents of all ages.

• Establish new partnerships with community behavioral health providers to provide seamless connections to treatment from the acute, post-acute or primary care settings

• Connect patients at risk for suicide to outpatient follow up program administered by Grassroots Crisis Intervention Center

• Implement urgent care psychiatric stabilization services with community provider- Way Station, Inc. Connect eligible residents to first follow up appointment within two business days.

• Number of patients referred

• Connection rate • Increase number of

patients with regular access to community-based behavioral health services

• Reduce avoidable hospital utilization

• Howard County Mental Health Authority

• Way Station, Inc. • Local Health Improvement

Coalition – Behavioral Health Work Group

• Grassroots Crisis Intervention Center

• National Alliance for Mental Illness (NAMI) Howard County

• The Horizon Foundation • Howard County Health

Department • HC Drug Free • On Our Own Howard

County • MD Chapter, American

Academy of Pediatrics

• Educate pediatricians and primary care practices on behavioral health resources and promote use of validated screening tool during visits

• Increase use of validated screening tool

• Howard County Mental Health Authority

• Advanced Primary Care Collaborative

• MD and Howard County Chapters, American Academy of Pediatrics

• Local Health Improvement Coalition – Behavioral Health Work Group


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Community Health Need Priority Area – Healthy Aging Goal Strategies Metrics Partners Improve the health of older adults living in Howard County and provide comprehensive care coordination for those with chronic conditions.

• Implement the Community Care Team to provide comprehensive care coordination services for chronically ill older adults with a focus on addressing social determinants of health

• Number enrolled in community care team

• Reduce hospital readmissions

• Reduce potentially avoidable utilization

• Community Care Team • Howard County Office on

Aging • Howard County Health

Department • Coalition of Geriatric

Services (COGS) • NeighborRide • Community Action Council • Transition Howard County

• Partner with post-acute, primary care and specialty care providers to facilitate more effective and person-centered transitions of care

• Number older adults linked to medical home

• Reduce hospital readmissions

• Reduce potentially avoidable utilization

• Local Health Improvement Coalition – Healthy Aging Work Group

• Lorien Health Systems • Gilchrist Services • Advanced Primary Care

Collaborative • Johns Hopkins Home Care • Howard County Office on

Aging


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Community Health Need Priority Area – Healthy Weight

Goal Strategies Metrics Partners Enable people of all ages and incomes to achieve and maintain a healthy weight.

• Implement nutrition standards for beverages sold in HCGH cafeteria

• Support LHIC advocacy work to update county food and beverage nutrition standards

• Support LHIC advocacy work to improve County Public School System’s Wellness Policy

• Decrease in availability of sugar sweetened beverages in HCGH cafeteria

• Decline in sales of sugar

sweetened beverages in HCGH cafeteria

• Decline in sugar sweetened

beverage sales at county level

• Johns Hopkins Health System

• Local Health Improvement Coalition – Healthy Weight Work Group

• Howard County Health Department

• The Horizon Foundation • People Acting Together in

Howard County (PATH) • American Heart Association

• Support programs including the Roving Radish and expanded Farmers Market locations (WIC office near Health Dept and Social Services) that increase access to healthy foods, especially for low-income families

• Increase number of Roving Radish meal kits sold

• Increase number of Roving Radish subsidized kits sold

• Increase use of Electronic Benefits Transfer (EBT) at farmers markets

• Howard County Government

• United Way of Central Maryland

• The Horizon Foundation • Howard County Farmers

Market Association • Howard County Economic

Development Authority • Howard County Health

Department • Howard County

Department of Social Services


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Community Health Need Priority Area – Healthy Weight (continued) Goal Strategies Metrics Partners

Enable people of all ages and incomes to achieve and maintain a healthy weight.

• Implement faith-based health initiative focused on screenings and delivery of evidence-based classes to reduce pre-hypertension and pre-diabetes and other chronic diseases closely linked to overweight and obesity

• Provide nutrition classes and counseling for county residents

• Implement multi-week walking program in North Laurel area of the county

• Support LHIC advocacy work on Complete Streets legislation at the county level

• Support Howard County bike share program

• Number of formal partnership with congregations/ faith-based organizations (signed covenants)

• Number of screenings held • Number of classes held • Measured weight loss for

class participants • Number of classes held • Number of participants • Bike share ridership

• Howard County Health Dept.

• The Horizon Foundation • Howard County Dept. of

Citizen Services • Parish Nurses • St Johns Baptist Church • Abiding Savior Lutheran • New Hope Lutheran • Atholton Seventh Day

Adventist • Columbia Community

Church • Celebration Church • Locust United Methodist

Church • Muslim Family Center • Iglesia de Dios Pentecostal • Unitarian Universalist

Columbia Congregation • Local Health Improvement

Coalition – Healthy Weight Work Group

• Maryland University of Integrative Health

• We Promote Health • Get Active Howard County • Howard County Office of

Transportation

Organization Contact InformationLHIC

Member Services ProvidedAccess to Care

Healthy Weight

Behavioral Health

Healthy Aging

A Better Way Counseling Services9017 Red Branch Rd., Suite 204Columbia, MD 21045Phone: 410-730-4500

Provides outpatient substance abuse program for adults & adolescents. Individual, group and family therapy, state certified program, drunk driving, X

African American Community Roundtable

P.O. Box 958 Columbia, MD 21044Phone: [email protected]

X An active coalition of social, civic, professional, religious, cultural, and political groups committed to enhancing the overall quality of life for African-Americans throughout Howard County.

X X

ALFA Specialty Pharmacy8940 Old Annapolis RoadColumbia, MD 21045Phone: 410-992-6676

X ALFA is dedicated to providing comprehensive pharmacy services to the long-term care community, medication therapy management (MTM), clinical research and compounding services to clients and the academic community.

X

American Center for Intellectual and Diverse Disorders (ACIDD) Maryland300 Thomas DriveLaurel, MD 20707Phone: 301-377-0750

Services to people with Mental Disorders and individuals with a dual diagnosis of Intellectual or Developmental Disability and Mental Illness X

American Diabetes Association2002 Clipper Park Road, Ste 110, Baltimore, MD 21211 Phone: 410-265-0075

X Prevent and cure diabetes and to improve the lives of all people affected by diabetes. X

American Heart Association217 E. Redwod Street, 23rd Fl Baltimore,MD 21202Phone: 410-246-6708

X Building healthier lives where you live and work and making your community healthier by advocating for key health issues. X

Arthritis Foundation9891 Broken Land Parkway, Suite 101Columbia, MD 21046Phone: 800-365-3811

Offers free health education events, resources on arthritis and related diseases, provides exercise classes nationwide. X

Association of Community Services

10480 Little Patuxent Pkw #920Columbia, MD 21044Phone: [email protected]

X A network of 100+ Howard County member organizations and individuals serving more than 100,000 Howard County families. X

BrightStar Care of Howard County5525 Twin Knolls Road, Suite 332Columbia, MD 21045Phone: 410-910-9425

Home care services including companion care, skilled home care, Alzheimer's & dementia care, child care, personal care and transportation services. X X

Capital Women's Care Howard County7625 Maple Lawn Blvd, Suite 1Fulton, MD 20759Phone: 410-531-7557

Capital Women’s Care Howard County offers comprehensive gynecologic and obstetric care, including well-woman exams, routine and high-risk obstetrics, family planning, treatment for heavy bleeding, menopause and urinary incontinence, minimally invasive surgery and postpartum care.

X X

Chase Brexton Health Services, Inc.

5500 Knoll North DriveSuites 370 & 400Columbia, MD 21045Phone: 410-837-2050

X Federally Qualified Health Center with a location in Howard County, MD. X X X X

Columbia Addictions Center5570 Sterrett Place, Suite 205Columbia, MD 21044Phone: 410-730-1333

Columbia Addictions Center provides comprehensive counseling to those in need; offers a wide array of services including substance abuse treatment, comprehensive mental health services, anger management, couples counseling, family counseling, intervention and specialized help for teens at risk.

X

Columbia Association6310 Hillside Court, Ste 100Columbia, MD 21046Phone: 410-715-3000

X Promoting health through physical activity and wellness. X X

Columbia Health Center8930 Stanford BlvdColumbia, MD 21045Phone: 410-313-7500

Howard County Health Department provides Reproductive Health Services to Howard County women, men and teens. We see uninsured or underinsured clients. Payments for services are based on a sliding fee scale.

X X

Columbia Medical Practice

5500 Knoll North DriveSte 180Columbia, MD 21045Phone: 410-964-6200

XProvides personalized, high-quality care for patients in Family Practice, Internal Medicine and Pediatrics.

X X X X

Community Action Council of Howard County6751 Columbia Gateway Drive, Box 226Columbia, MD 21046 Phone: 410-313-6440

X Helps low income residents in the areas of housing, energy assistance, food and education. Also operates Head Start program. X X X X

Congruent Counseling Services, LLC & Integrative Counseling, LLC

10630 Little Patuxent Parkway, Suite 209 and 209AColumbia, MD 21044Phone: 410-740-8066

Mental health and substance abuse care and counseling including depression, grief counseling, cognitive behavioral therapy, anger management, suicide prevention and addictions counseling. Buprenorphine certified physicians and treatment providers.

X

East Columbia 50+ Center6600 Cradlerock WayColumbia, MD 21045Phone: 410-313-7680

Venue for various activities for seniors 50+. X X

Elkridge 50+ Center6540 Washington Blvd.Elkridge, MD 21075Phone: 410-313-4930


Ellicott City Senior Center and Senior Center Plus9401 Frederick RoadEllicott City, MD 21042Phone: 410-313-1400

Venue for various activities for seniors 50+ and structured activities for older adults who need extra care. X X

Evergreen Health Care9710 Patuxent Woods Dr. Ste 200Columbia, MD 21046Phone: 301-575-8080

X Health insurance co-op. X X X X

FIRN5999 Harpers Farm Rd, Columbia, MD 21044Phone: [email protected]

X Empowers immigrants, refugees, asylees and other foreign-born individuals by helping them to access community resources and opportunities. X

Florence Bain Senior Center5470 Ruth Keeton WayColumbia, MD 21044Phone: 410-313-7213


Gilchrist Hospice Care5537 Twin Knolls Rd, Suite 433Columbia, MD 21045Phone: 410-730-5072

Services include medical and nursing care, social work support, home health and volunteer assistance, as well as spiritual and grief counseling. X

Girls on the Run of Central Maryland

9150 Rumsey Road Suite A7Columbia, MD 21045Phone: 443-583-7740

X Empowers girls to make healthy choices in their lives, to develop leadership skills, and to develop self-confidence and self-respect. X

HCGH Resource InventoryLink to Community Health Priority Areas

APPENDIX B



Healthy Weight

Behavioral Health

Healthy Aging

Glenwood 50+ Center2400 Route 97Cooksville, MD 21723Phone: 410-313-5440


Grassroots Crisis Intervention Center6700 Freetown RdColumbia, MD 21044Phone: 410-531-6006

X A crisis intervention center providing 24-hour crisis intervention services, emergency and transitional shelter, and community education. X X

Guardian Primary Care ServicesColumbia, MD 21044Phone: 443-367-8600

X Primary care practice providing quality, affordable, patient centered, telemedicine care and home visit treatment utilizing a holistic approach. X X X X

HC DrugFree

Wilde Lake Village Center5305 Village Center Drive, Ste 206Columbia, MD 21044Phone : 443-325-0040 [email protected]

X HC DrugFree provides prevention, treatment, recovery, health and wellness resources to help Howard County residents develop knowledge and skills to understand and address behavioral health disorders.

X

Health Promotion On Call

10280 Old Columbia Rd, Ste 220Columbia, MD 21046Phone: [email protected]

X Nutrition services X

Healthy Howard8930 Stanford Blvd.Columbia, MD 21045Phone: 888-973-3155

XHealthy Howard is a nonprofit based in Columbia, Md., that strives to serve as an innovative leader impacting quality of life in the community through the delivery of effective health programs, services and resources. Programs focus on improving access to health care, promoting healthy lifestyles, building strong community partnerships for health and providing care coordination.

X X X X

Horizon Foundation10480 Little Patuxent Pkwy, #900 Columbia, MD 21044 Phone: 410-715-0311 [email protected]

X Local health and wellness philanthropy. X X X X

Howard Community College10901 Little Patuxent PkwyColumbia, MD 21044Phone: 443-518-1000

X HCC offers two-year degree and certificate programs built around careers that are in demand. Students of all ages and educational levels also can prepare for a new career, sharpen job skills or explore personal interests through the many programs in our noncredit, Continuing Education and Workforce Development

X

Howard County Dental Association Phone: 410-635-0703 [email protected]

X The HCDA is active in oral health literacy presentations by dental health professionals to reinforce school curricula. X X

Howard County Dental Hygienists' Association [email protected] X The HCDHA is committed to ensuring access to quality oral health care and increasing awareness of the cost-effective benefits of prevention by educating the local community on the importance of quality preventative dental care to improve total health.

X X

Howard County Department of Citizen Services/Office on Aging6751 Columbia Gateway Drive,Columbia, MD 21046Phone: 410-313-6400/410-313-6410

X Improving the health of senior citizens through a variety of programs. X X X X

Howard County Department of Social Services7121 Columbia Gateway Dr,Columbia, Md 21046Phone: 410-872-8700

X Provides Social Service programs to residents - children - adult. X X X X

Howard County General Hospital5755 Cedar LaneColumbia, MD 21044Phone:410-740-7890

Howard County General Hospital: A Member of Johns Hopkins Medicine is a comprehensive, acute-care medical center with 266 licensed beds specializing in women`s and children`s services, surgery, cardiology, oncology, orthopedics, gerontology, psychiatry, emergency services, and community health education.

X X X X

Howard County Government

George Howard Building3430 Court House DriveEllicott City, MD 21043Phone: 410-313-2022

X Since there are no incorporated cities or towns in Howard County, the county government provides all local government services including administration of the operating and capital budgets, zoning, enacting laws for the county, helping residents resolve problems.and handling criminal, civil and juvenile court matters.

X X X X

Howard County Health Department8930 Stanford Blvd, Cloumbia, MD 21045Phone: [email protected]

X Public Health programs to benefit residents. X X X X

Howard County Library System

Administrative Branch9411 Frederick RoadEllicott City, MDPhone: 410-313-7750

XProvides educational materials in all formats from a collection of one million items housed at six branches and a vast array of e-resources, provides research assistance and instruction and offers experiences with community partnerships, including A+ Partners in Education, Choose Civility, and Well & Wise, as well many signature events, such as the HCLS Spelling Bee, BumbleBee, Battle of the Books, Rube Goldberg Challenge, Summer Reading Kickoff, notable author events, and Evening in the Stacks.

X X

Howard County Mental Health Authority

8930 Stanford Blvd,Columbia, MD 21045Phone: [email protected]

X Plan, manage, and monitor publicly funded mental health services for residents. X X

Howard County Public School System10910 Clarksville PikeEllicott Cityk, MD 21042Phone: 410-313-6600

X Cultivate a vibrant learning for students to thrive. X X X

Howard County Recreation and Parks7120 Oakland Mills Rd, Columbia, MD 21046 Phone: 410-313-4700

X Provide services in child care, outdoor recreation, physical activity and more for residents. X X

Humanim

6355 Woodside Court, Columbia, MD 21046Phone: [email protected]

X Provide workforce development services, deaf services, developmental disability and mental health services. X X

JAEL Health Services, Inc.10176 Baltimore National Pike, Unit 115Ellicott City, MD 21042Phone: 410-203-2120

Methadone maintenance treatment offered to persons who are addicted to illicit opiates and/or prescription narcotics for over a year. x

Johns Hopkins Community Physicians6350 Stevens Forest RoadColumbia, MD 21046 Phone: 443-259-3770

Family and Internal Medicine, Obstetrics and Gynecology, and Pediatrics. X X X X

Johns Hopkins Community Physicians8160 Maple Lawn Blvd, Suite 150Fulton, MD 20759Phone: 240-459-1800

Family medicine services. X X X X

Johns Hopkins Community Physicians - General Surgery at Howard County

Medical Arts Building11085 Little Patexent Parkway, Suite 103Columbia, MD 21044Phone: 410-730-1988

Colorectal and general surgery services. X X

Johns Hopkins Community Physicians - Pulmonology & Sleep Medicine

Medical Arts Building11085 Little Patexent Parkway, Suite 201Columbia, MD 21044Phone: 410-715-1060

Pulmonary medicine and sleep medicine services. X X

Kindred Spirits at Glenwood9400 Route 97Cooksville, MD 21723Phone: 410-313-5441

The Kindred Spirits Social Club provides a place for people diagnosed with an early stage memory disorder to interact with other people walking the same journey: held Monday, Wednesday, Friday 9a-1p.

X X

Kindred Spirits at North Laurel9411 Whickey Bottom RdLaurel, MD 20723Phone: 410-313-7691

The Kindred Spirits Social Club provides a place for people diagnosed with an early stage memory disorder to interact with other people walking the same journey; held Tuesday & Thursday 9:30a - 1:30p.

X X

mailto:[email protected]



Healthy Weight

Behavioral Health

Healthy Aging

Kolmac Clinic10632 Little Patuxent Parkway, Suite 410Columbia, MD 21044Phone: 443-276-0556

Addiction services including detoxification, rehabilitation and continuing care. x

Longwood 50+ Center6150 Foreland GarthColumbia, MDPhone: 410-313-7217


Maryland Access PointHoward Cnty Office on Aging 6751 Columbia Gateway Dr, 2nd FL, Columbia, MD 21046Phone: 410-313-5980

Maryland Access Point of Howard County (MAP) is a trusted source of information and assistance for Howard County residents who need or want to plan for their immediate and future needs. MAP serves adults 50 years and older, adults 18 years and older with a disability, family members and other caregivers, and health or business professionals.

X X X X

Maryland Centers for Psychiatry

David Robert McDuff, M.D.3454 Ellicott Center Dr, Suite 106Ellicott City, MD 21043Phone: 410-461-3760

Buprenorphone certified physicians and treatment providers. X

Maryland University of Integrative Health7750 Montpelier RoadLaurel, MD 20723Phone: 410-888-9048

X MUIH has educated practitioners in health and wellness through transformative and relationship-centered programs that draw from traditional wisdom and contemporary science. MUIH offers graduate degrees and certificates in a wide range of wellness fields, as well as programs for professional and personal developmen

X X X X

MD Chapter of the American Academy of Pediatrics1211 Cathedral St. Baltimore, MD 21201Phone: 410-878-9702

X Provides communication among pediatricians, parents and other persons interested in the promotion of good health for children. X X X

Meals on Wheels of Central Maryland

Southwest Office 5305 Village Center Drive, Suite 214Columbia, MD 21044Phone: 410-730-9476

Meal service provided to homebound people due to age or disability and grocery assistance program for homebound, elderly and disabled clients who cannot shop for themselves.

X

Millenium Family Practive

Njideka Udochi, M.D.8900 Columbia Parkway, Suite GColumbia, MD 21045Phone: 410-740-9001

Buprenorphone certified physicians and treatment providers. X

National Alliance on Mental Illness (NAMI) Howard County

9650 Santiago Rd, #1Columbia, MD 21045Phone: [email protected]

X Improves the lives of individuals and families living with mental illness through support, education, and advocacy. X X

North Laurel 50+ Center9411 Whickey Bottom RdLaurel, MD 20723Phone: 410-313-0380


On Our Own of Howard County, Inc.6440 Dobbin Rd, Columbia, MD 21045Phone: 410-772-7905

X Mental health education and advocacy for people who receive mental health services and develops alternative, recovery-based mental health initiatives. X

Salvere Health and Fitness10260 Old Columbia Rd, B1, Columbia, MD 21046 Phone: 410-707-0055 [email protected]

Health and fitness services. X

Silverman Treatment Solutions8930 Stanford Blvd, Suite M100Columbia, MD 21045Phone: 443-285-0807

Outpatient treatment for patients seeking effective treatment for addictions who do not require - or who have completed - detoxification, residential treatment or day treatment.

X

The Load Closet of Howard County

Long Reach Village8775 Cloudleap Court, Suite 11Columbia, MD 21045Phone: 410-313-0363

The purpose of the Loan Closet of Howard County is a clearinghouse of donated medical equipment for temporary use to all Howard County residents. Many residents in need of medical equipment may not be able to afford these items, or they may only need equipment for a short period of time. Others have medical equipment they no longer need. The Loan Closet brings these two communities of people together.

The Village in Howard5466 Ruth Keeton WayColumbia, MD 21044Phone: 443-367-9043

XThe Village in Howard is a member-based community of Howard County residents 55 and older who want to continue to live independently in the homes and neighborhoods they know. Membership benefits include, not only various social and cultural activities, but access to various services such as transportation, home repair from vetted contractors, and assistance with simple house maintenance. These benefits enable members to actively age in place.

X

Transition Howard County2814 Montclair DriveEllicott City, MD 21043

X Transition Howard County is an all-volunteer organization that is focused on making the communities of Howard County more resilient and sustainable. Transition Howard County has active committees focused on the following areas: ecosystem landscaping, economy, energy, food, health, knowledge, outreach and water.

X X

Tuerk House, Inc., Howard House4100 College Ave, Building #8Ellicott City, MD 21043Phone: 410-313-1458

Men's halfway house for substance abuse recovery; prevides wraparound services including job counseling, x

United Way of Central Maryland10480 Little Patuxent Pkwy, #900Columbia, MD 21044Phone: 410-739-1319

X Services to support families to achieve quality educaiton, financial stability and good health. X X X X

University of Maryland Extension3300 N Ridge Rd, Ste 240Ellicott City, MD 21043Phone: 410-313-2707

X Non-formal education system to promote agriculture, health and wellness and more. X

Walgreens5585 Twin Knolls RoadColumbia, MD 21045Phone: 410-730-2789

X Pharmacy, immunization and education services provided. X X

Way Station9030 MD-108, Columbia, MD 21045Phone: 410-740-1901

X A behavioral health non-profit that provides a broad range of services in a variety of settings to meet the needs of children, adolescents, adults, and families. X X

We Promote Health

5052 Dorsey Hall Dr.,Suite 203Ellicott City, MD 21042Phone: [email protected]

X Through events and programs, strengthens the collaborative focus on wellness for every individual and organization in Howard County. X

Wellness Center at Howard County General Hospital

Medical Pavilion at Howard County10710 Charter Dr, Suite 100Columbia, MD 21044Phone: 410-740-7601

The HCGH Wellness Center provides outreach and education to the Howard County community. Located in the new Medical Pavilion at Howard County, the Wellness Center offers a wide range of classes, screenings and fitness programs both in the Wellness Center and in community settings throughout the area ranging from CPR instruction to child and adult safety classes to diet and nutrition counseling.

X X X X

Y of Central Maryland4331 Montgomery RdEllicott City, MD 21043Phone: 410-465-4334

X Through programming, develops the full potential of every individual that builds healthy spirit, mind and body for all. X

Project Overview

The mission of this public study, known as the Howard County Health Assessment Survey (HCHAS), is to assess health-related behaviors and risk factors among the adult population of Howard County, Maryland. Results of this study enable health providers and advocates to measure progress and to know where to focus resources to help make the community healthier. The Horizon Foundation sponsored this study, joined by the Howard County Health Department, Howard County General Hospital, and the Columbia Association. This is a biennial study, first conducted in 2012, and updated in 2014. The survey approach and methodology were modeled after the Federal Behavioral Risk Factor Surveillance System (BRFSS), which is conducted by Maryland and the other states under the auspices of the Centers for Disease Control and Prevention (CDC). Survey Methodology

The study sponsors met regularly during the planning phase to discuss survey content and methodology. Final decisions over survey content were made by the sponsors. Technical aspects of the survey project, including question wording recommendations, population sampling, and telephone data collection were administered by OpinionWorks, LLC, of Annapolis, Maryland. Many questions on the HCHAS were replicated from the BRFSS so that results can be compared to other areas of Maryland and the nation, and to benefit from prior vetting of those questions. The survey also included customized questions to address the priorities of the project’s sponsors, and the local health environment in Howard County. In the end, these telephone interviews averaged 18.4 minutes. Field interviews were collected during the period July 8 – August 18, 2014. Prior to field interviewing, the Howard County Health Department notified the public about the study, and as necessary fielded telephone inquiries from the public about the purposes of the study. OpinionWorks, the survey contractor, maintained a dedicated telephone line, named “Howard Health Survey,” the number and name of which appeared on residents’ caller ID readouts as interview calls were made; this phone number was monitored daily by the contractor and calls were returned by the study’s project manager to residents who had questions about the study. During the interviewing process, a strict random respondent selection protocol was adhered to. Respondent selection within households was randomized, and all households in the County had an equal probability of being sampled. Caregivers were not allowed to answer for others; answers for all study respondents reflected their own characteristics and experience. The population sample was stratified, based on Howard County’s seven Regional Planning Districts (RPDs). Five sampling areas were created, with the three westernmost RPDs combined into one for sampling purposes. This approach allowed each of these five geographic areas to be sampled and analyzed with a reasonable level

2014 Howard County Health Assessment Survey - Report of Findings 23

of statistical confidence. Once the interviews were collected, weights were applied at the Census Tract level to bring the sample into close conformity with the distribution of the adult population countywide, according to the most recent data available from the United States Census Bureau. Accordingly, a total of 2,000 interviews were conducted, as follows:

RPD-Based Sampling Area Interviews Conducted Maximum Sampling Error* West County 400 ± 4.9% Ellicott City 425 ± 4.7% Columbia 425 ± 4.7% Elkridge 392 ± 4.9% Laurel 358 ± 5.2%

Howard County Total 2000 ± 2.1%

*Sampling error is calculated at the 95% confidence level. This means that, in 19 out of 20 cases we can be certain that the true results would fall within this range if every adult resident of these areas had been interviewed.

Interviews were considered completed if the respondent proceeded through the entire interview, though respondents may have refused to answer individual questions. Interviews were conducted in English and Spanish. Both landline and mobile telephone numbers were included in the sampling frame. In addition to the geographic weights by Census Tract, demographic weights were applied to the sample to ensure that it was as reflective as possible of the County’s population. Weights were applied to the following parameters: gender, age, race and ethnicity, and educational attainment. A complete survey data file has been supplied by the contractor to the study sponsors, excluding identifying information for the individual respondents in order to protect their personal health information. The Structure of This Report

This report provides a visual representation of each question on the survey, grouped by major topic area. Those major topics are:

1. Access to Care

2. Obesity and Healthy Living

3. Behavioral Health

4. Chronic Disease

5. Other Issues


Where a question was repeated from the 2012 survey, trends from the prior survey are illustrated. In cases where a questions was not asked in the 2012 survey, or where question wording was significantly changed, 2012 data do not appear in this report. Survey results have also been broken out for a variety of geographic, demographic, and lifestyle indicators, so that propensities can be isolated within population subgroups. On the pages that follow, subgroup numbers have been placed in tables beneath each question in cases where there are statistically-significant differences within those subgroups. Therefore, not all subgroups are listed for each question. The raw number of interviews collected in each subgroup is listed in parentheses below, followed by the weighted number reflecting that subgroup’s proportion of the overall countywide survey sample once the results were weighted to reflect the population distribution of Howard County (raw number → weighted number). These subgroups are:

• Regional Planning District: West County, which combines the less populous Cooksville, West Friendship, and Clarksville Regional Planning Districts (400 raw number → 343 weighted number); Ellicott City (425 → 456); Columbia (425 → 717); Elkridge (392 → 339); and Laurel (358 → 324).

• Gender: Male (905 → 1036), Female (1095 → 1143).

• Age: 18 to 34 (282 → 600), 35 to 49 (918 → 748), 50 to 64 (477 → 490), and 65 or older (304 → 321).

• Race/Ethnicity: White (1474 → 1333); Black or African-American (287 → 437); Asian (174 → 302); Hispanic (42 → 128); and Others, such as Native Hawaiian or Other Pacific Islander, American Indian or Alaska Native (79 → 127). Note that survey participants could choose more than one of these categories to describe themselves.

• Presence of Children under Age 18 in the Household: Yes (1057 → 1060), No (930 → 1108).

• Household Income: Less than $50,000 per year (215 → 388); $50,000 to $99,999 per year (395 → 458); $100,000 to $149,999 per year (461 → 454); $150,000 to $199,999 per year (306 → 290); $200,000 or more per year (327 → 257).

• Educational Attainment: High School Diploma/GED or less (191 → 437), Attended some college (288 → 421), 4-year college degree (584 → 661), Graduate-level work or degree (931 → 654).

• Employment Status: Employed for wages (1296 → 1291); Self-employed (152 → 151); Unemployed (49 → 96); Retired (268 → 298); or another status such as student, homemaker, or unable to work (229 → 327).


• Marital Status: Married (1487 → 1362), Divorced or separated (170 → 199), Widowed (88 → 121), Never married (222 → 449), or a member of an unmarried couple (26 → 39).

In many cases throughout this survey, the percentage of respondents who were not sure amounted to less than one-half percent. In those cases, where “not sure” equals or rounds to 0% of respondents, “not sure” does not appear as a response in the graphics below. It should also be noted that throughout this report, it will occasionally appear that columns of numbers do not add correctly; those minor differences (for example a column of numbers that adds to 99% or 101%) are typically due to issues of rounding.


Table of Contents

Question # Topic Page Access to Care

3.1 Health care coverage 7 3.2 Personal health care provider 9 3.3 Could not see a doctor because of cost 10

3.3A Typical health care provider 11 3.3B Wait for appointment 13 3.3C Emergency room visit in lieu of doctor appointment 14

M12.1 Mammograms 16 M12.2 Last mammogram 17

M12.3R Last breast exam 18 M12.5 Pap test 20

M12.5A Last Pap test 21 M14.1 Blood stool test 22

M14.3R Sigmoidoscopy/Colonoscopy 23 MD3-1 Time since last dental visit 24 MD4-1 Did not get dental care 26 MD4-2 Reason for not seeing dentist 27

Obesity and Healthy Living BMI Calculated Body Mass Index 29

8.12A Advised by doctor to lose weight 30 8.12B Trying to lose weight 31

9.2R Eating fruit 32 9.4R Eating vegetables 34

9.2R/9.4R Daily fruit and vegetable consumption 36 10.1A Physical activities or exercise 37 10.2A Frequency of physical activity 39 10.3A Location of physical activity 40 10.4A Physical activities to strengthen muscles 41 10.5A Frequency of activity to strengthen muscles 42 10.6A Location of activity to strengthen muscles 43

SD1 Regular soda 44 SD2 Sports drinks 45 SD3 Other types of sugar-sweetened drinks 46 SD4 Children drinking soda 48 SD5 Children drinking sports drinks 49 SD6 Children drinking other sugar-sweetened drinks 50 SD7 Has bought sugar-sweetened drinks 51

Behavioral Health M26.9 Mental health condition 52 M28.1 Money worries 53

M28.1A Did not get mental health treatment 55


M28.1B Reason for lack of mental health treatment 56 7.1 Smoked at least 100 cigarettes 57 7.2 Smoking frequency 58 7.5 Other tobacco products 59

7.5A E-cigarettes 60 M16.2 Secondhand smoke at home 61 M16.3 Secondhand smoke in vehicle 62

M16.5A Smell tobacco smoke from neighbors 63 15.1 Days consuming an alcoholic drink 65 15.3 Binge drinking 67

Chronic Disease 4.1 High blood pressure 69

4.1A High blood pressure medication 71 5.1 Blood cholesterol test 72 5.2 Last cholesterol test 73 5.3 Blood cholesterol is high 75 6.5 Asthma 76 6.8 COPD, Emphysema, or Chronic Bronchitis 77

6.13 Diabetes 78 M01.2 Pre-diabetes 80 M02.1 Age at diabetes diagnosis 81 M02.2 Taking medicine for diabetes 82 M02.5 Health care visits for diabetes 83 M02.6 Times A1C Tested 84

11.2 Health problem requiring special equipment 86 11.2A Special in-home care 87

Other Issues LD2 Lyme disease 88

Appendix Survey Instrument A-1


Access to Care The Access to Care section includes questions about the incidence of health care coverage by residents, whether they feel they have a personal doctor or health care provider, whether cost or availability has been a barrier to seeing a primary care provider when they needed one, where they typically go for their care, and how knowledgeable they feel about the Affordable Care Act. This section also addresses the incidence of mammograms, breast exams, Pap tests, cancer screenings, and dental care. Level of Health Care Coverage for Howard County Residents

Ninety-five percent of Howard County adult residents had health care coverage in 2014. This is an increase from 93% coverage during the previous biennial survey in 2012.

2014 Planning District Breakouts West County Ellicott City Columbia Elkridge Laurel

Yes 97% 97% 93% 92% 95% No 3% 3% 7% 6% 5% Not sure - - - 1% -


2014 Age Breakouts 18-34 35-49 50-64 65+

Yes 89% 95% 97% 98% No 10% 5% 3% 2% Not sure 1% - - -

2014 Race/ Ethnicity Breakouts White African-

American Asian Hispanic Other

Yes 96% 90% 97% 90% 90% No 4% 10% 3% 7% 10% Not sure - - - 3% -

2014 Education Breakouts High School or less Some College 4-Year

Degree Postgraduate

Yes 88% 91% 97% 99% No 12% 9% 3% 1% Not sure - - - 1%

2014 Income Breakouts <$50,000 $50,000-$99,999

$100,000- $149,999

$150,000- $199,999 $200,000+

Yes 88% 96% 95% 98% 99% No 12% 3% 5% 2% 1% Not sure - 1% - - -

2014 Employment Status Breakouts Employed Self-

Employed Unemployed Retired Other

Yes 96% 90% 78% 98% 91% No 3% 10% 22% 2% 9% Not sure - - - - -


Nine out of ten Howard County residents (90%) have at least one person that they think of as their personal doctor or health care provider. This is an increase from 87% in 2012. In 2014, 80% said they have one person they think of this way, and 10% said there is more than one.

2014 Age Breakouts 18-34 35-49 50-64 65+

Yes 76% 77% 86% 87% More than one 9% 13% 9% 9% No 14% 10% 5% 4% Not sure/Refused 1% *% *% -



Yes 80% 81% 79% 70% 74% More than one 11% 8% 11% 12% 4% No 9% 11% 7% 18% 22% Not sure/Refused *% *% 2% - -



$100,000- $149,999

$150,000- $199,999 $200,000+

Yes 76% 81% 83% 77% 83% More than one 10% 8% 8% 18% 9% No 12% 10% 8% 5% 7% Not sure/Refused 2% - *% *% -


Degree Postgraduate

Yes 84% 78% 79% 81% More than one 4% 14% 11% 10% No 12% 8% 8% 9% Not sure/Refused - - 2% -

Six percent of residents said there was a time in the past 12 months when they needed to see a doctor but could not do so because of cost. This is a decrease from the 8% measured in 2012.


Yes 4% 2% 9% 6% 5% No 96% 98% 91% 94% 94% Not sure - - - - -



$100,000- $149,999

$150,000- $199,999 $200,000+

Yes 16% 5% 3% - 2% No 84% 94% 97% 99% 98% Not sure - - - - -


Degree Postgraduate

Yes 9% 10% 3% 3% No 90% 90% 97% 97% Not sure - - - -



Yes 3% 11% 34% 1% 10% No 97% 89% 66% 99% 90% Not sure - - - - -

Three-quarters of residents (74%) in 2014 said they usually go to a doctor’s office when they are sick or need medical attention. This is a decrease of three percentage points since 2012. Meanwhile, urgent care has increased from 11% to 15% in that same time period.



A doctor's office 77% 79% 68% 77% 74%

An urgent care center 11% 13% 18% 16% 14%

A hospital emergency room 1% - 5% 2% 3% A community health center 1% 1% 2% 2% 3%

Some other kind of place 1% - 2% ` 1%

No usual place 5% 5% 4% 1% 4%

Not sure 2% 1% 1% - -

2014 Age Breakouts 18-34 35-49 50-64 65+

A doctor's office 64% 71% 84% 85%

An urgent care center 22% 19% 6% 4% A community health center 3% 1% 3% 1%

A hospital emergency room 3% 3% 2% 3%

Some other kind of place - 1% - 4%

No usual place 6% 4% 3% 2%

Not sure 1% - 2% 1%


$100,000- $149,999

$150,000- $199,999 $200,000+

A doctor's office 62% 75% 78% 76% 80%

An urgent care center 15% 16% 14% 20% 13%

A hospital emergency room 7% 1% 1% 1% 2% A community health center 5% 2% 1% 1% -

Some other kind of place 4% 1% 1% 1% -

No usual place 6% 3% 5% 1% 4%

Not sure 1% 2% 1% - 1%


The last time they needed a medical issue resolved quickly, 33% of residents were able to see their primary health care provider within the same day, and another 28% within two to three days. Twenty-eight percent had to wait longer than three days, and 11% waited longer than a week. This question was not asked in 2012.


Same day 35% 34% 33% 39% 26% Within 2-3 days 25% 27% 28% 31% 30% Within 1 week 17% 19% 17% 14% 18% Longer than 1 week 12% 11% 10% 7% 15% Does not apply to me 6% 5% 8% 6% 6% Not sure 4% 4% 4% 2% 4%


Degree Postgraduate

Same day 32% 35% 33% 32% Within 2-3 days 26% 28% 30% 28% Within 1 week 19% 19% 16% 16% Longer than 1 week 11% 10% 10% 13% Does not apply to me 9% 6% 5% 8% Not sure 3% 1% 5% 4%


2014 Marital Status Breakouts Married Divorced/

Separated Widowed Never Married

Unmarried Couple

Same day 34% 24% 37% 34% 30% Within 2-3 days 28% 27% 27% 30% 28% Within 1 week 17% 19% 7% 20% 15% Longer than 1 week 10% 17% 9% 9% 20% Does not apply to me 7% 10% 16% 2% 7% Not sure 3% 3% 4% 5% -

Seven percent of residents said there was a time in the past 12 when they needed to go to an emergency room because they could not get a timely appointment with a doctor. This measure of access has worsened slightly from 5% in 2012 to 7% in 2014.


Yes 3% 5% 10% 5% 7% No 96% 94% 89% 94% 92% Not sure - - 1% - 1%




Yes 5% 11% 7% 9% 8% No 94% 89% 93% 89% 91% Not sure - - - 2% 1%


Degree Postgraduate

Yes 10% 10% 5% 4% No 89% 89% 95% 95% Not sure/ Refused 1% 1% - 1%

2014 Parent Breakouts Has Children No Children

Yes 8% 5% No 91% 94% Not sure 1% -


Screenings

Ninety-three percent of the women over 40 in Howard County have had a mammogram. This number is virtually unchanged from the 92% recorded in 2012.



Yes 95% 96% 70% 69% 80% No 4% 4% 28% 31% 20% Not sure - - 3% - -


Eight-eight percent of the women who have had a mammogram had it within the prior two years. Seven percent had their last mammogram between two and five years ago; for 4%, it has been longer than five years.



Unmarried Couple

Within the past 2 years 89% 92% 73% 96% 84% 2 years but less than 5 years ago 7% 3% 15% 3% 16%

5 or more years ago 3% 3% 10% 1% -

Not sure/ Refused 1% 2% 1% - -


Seventy-two percent of women in Howard County had a clinical breast exam in the 12 months prior to the survey. This was a slight decline from the 76% who had had a breast exam during the 12 months prior to the 2012 survey. Another 14% in 2014 and 11% in 2012 had had a breast exam between 12 and 24 months prior.


Within the past year 64% 68% 76% 71% 73% 1 year but less than 2 years ago 21% 14% 11% 13% 17%

2 years but less than 3 years ago 2% 2% 4% 5% 6%


5 or more years ago 2% 4% 2% 3% - Have never had a clinical breast exam 7% 5% 3% 5% 2%

Not sure/ Refused - 4% 4% 4% -






3 years but less than 5 years ago 2% 1% 3% - -

5 or more years ago 3% 2% 1% - - Have never had a clinical breast exam 2% 2% 25% 1% 3%

Not sure/ Refused 2% - 2% 12% 14%


Degree Post-

graduate

Within the past year 63% 69% 77% 77% 1 year but less than 2 years ago 13% 17% 15% 12%

2 years but less than 3 years ago 3% 6% 4% 2%

3 years but less than 5 years ago - 2% 2% 2%

5 or more years ago 5% 1% 1% 2% Have never had a clinical breast exam 12% 1% 1% 3%

Not sure/ Refused 5% 4% 1% 1%



Unmarried Couple


2 years but less than 3 years ago 4% 3% 6% 3% -

3 years but less than 5 years ago 1% 2% 2% 3% -

5 or more years ago 1% 2% 14% 1% - Have never had a clinical breast exam 1% 5% - 18% 9%

Not sure/ Refused 1% 1% 10% 5% -


Eighty-nine percent of women in 2014 said they have had a Pap test. This is a decline from the 94% who said so in 2012.



Yes 94% 85% 71% 81% 99% No 5% 15% 28% 19% 1% Not sure - - 1% - -


$100,000- $149,999

$150,000- $199,999 $200,000+

Yes 87% 93% 94% 79% 98% No 12% 7% 5% 19% 2% Not sure/ Refused - - 1% 2% -


Degree Postgraduate

Yes 80% 84% 94% 97% No 20% 15% 6% 3% Not sure/ Refused - 1% - 1%


Of the women who have had a Pap test, 77% said their test was within the prior two years; 13% had the test between two and five year previously, and 9% said their Pap test was five or more years ago.

2014 Age Breakouts 18-34 35-49 50-64 65+

Within the past 2 years 90% 85% 76% 47% 2 years but less than 5 years ago 10% 12% 12% 18%

5 or more years ago - 3% 10% 31%

Not sure - - 1% 4%


$100,000- $149,999

$150,000- $199,999 $200,000+


5 or more years ago 16% 8% 5% 3% 3%

Not sure 1% - 1% - 2%



Degree Post-

graduate


5 or more years ago 20% 9% 5% 4%

Not sure - 1% 2% 1%


Employed Un-employed Retired Other


5 or more years ago 4% 5% 29% 28% 3%

Not sure 1% - - 3% -

Forty percent of residents over the age of 50 have used a blood stool test at home. This percentage is virtually unchanged from 2012.



Yes 49% 41% 29% 45% 41% No 51% 55% 71% 55% 57% Not sure/ Refused - 4% - - 2%



Yes 46% 25% 24% 16% 26% No 52% 75% 74% 84% 74% Not sure 2% - 2% - -

Seventy-nine percent of residents over age 50 have had a sigmoidoscopy or colonoscopy; 62% have had this exam within the past five years.





10 or more years ago 3% 5% 2% - 4%

Not sure/ Refused 3% 1% 7% - -

Have never had a sigmoid-oscopy or colonoscopy 16% 23% 36% 70% 30%


Degree Post-

graduate



Not sure/ Refused 1% 3% 4% 2%

Have never had a sigmoid-oscopy or colonoscopy 32% 10% 17% 16%

Eighty percent of residents had visited a dentist or dental clinic within the prior 12 months. Another 9% had a dental visit between one and two years ago. These numbers were nearly identical in 2012.






Never - 1% 1% - 1%

Not sure/ Refused 1% 4% 1% 3% 1%


$100,000- $149,999

$150,000- $199,999 $200,000+

Within the past year 61% 76% 87% 89% 94%

1 year but less than 2 years ago 18% 11% 5% 6% 5%



Never 2% - - - -

Not sure/ Refused 4% 1% 1% 1% -


Degree Post-

graduate




Never 2% 1% - -

Not sure/ Refused 3% 1% 2% -


Eleven percent of residents said they had a dental problem in the prior 12 months where they would have liked to have seen a dentist but did not do so. In 2012, the percentage was a slightly lower 9%.

2014 Age Breakouts 18-34 35-49 50-64 65+

Yes 17% 10% 10% 3% No 83% 90% 89% 94% Not sure/ Refused - - - 3%



Yes 8% 18% 13% 27% 28% No 92% 81% 87% 73% 72% Not sure - 1% - - -


Degree Postgraduate

Yes 16% 16% 8% 7% No 81% 84% 92% 93% Not sure/ Refused 2% - - -


Cost (41%) and lack of time (24%) were the two main reasons people did not see the dentist when they wanted to.


It would cost too much 19% 32% 44% 31% 65%

Didn't have time 25% 47% 14% 47% 3% Didn't have anyone to care for my children - - 2% 3% -

Couldn't get an appointment 2% - 1% - 1%

Would have to travel too far - - - 3% - Didn't have a way to get there - - - - 1%

Some other reason 46% 21% 35% 17% 31%

Not sure/ Refused 7% - 4% - -



$100,000- $149,999

$150,000- $199,999 $200,000+

It would cost too much 49% 50% 18% 4% -

Didn't have time 19% 16% 25% 37% 58%

Didn't have anyone to care for my children - 6% - - -

Couldn't get an appointment - 2% 1% 2% -

Would have to travel too far - 2% - - - Didn't have a way to get there - - - - -

Some other reason 25% 23% 56% 57% 42%

Not sure/ Refused 5% - - - -


Obesity & Healthy Living The Obesity & Healthy Living Section includes a calculated average Body Mass Index (BMI) for Howard County based on survey responses, and questions about being overweight and trying to lose weight, consumption of fruits and vegetables, aerobic and strengthening physical activity, and consumption of sugary drinks. Obesity

Based on survey questions about residents’ height and weight, 33% of the Howard County population is overweight, and 23% is obese. The average BMI for the County is 26.65, or somewhat overweight. There is no significant change in these percentages since 2012.



Not Overweight/ Obese (BMI < 25.00) 41% 39% 64% 47% 46%

Overweight (BMI 25.00 - 29.99) 36% 27% 28% 27% 26%

Obese (BMI 30.00+) 23% 34% 8% 26% 27%

Mean 26.87 28.07 23.90 26.03 26.30



$100,000- $149,999

$150,000- $199,999 $200,000+


Overweight (BMI 25.00 - 29.99) 29% 31% 36% 36% 33%

Obese (BMI 30.00+) 30% 30% 22% 17% 20%

Mean 27.49 27.62 26.69 26.00 26.16



Unmarried Couple


Overweight (BMI 25.00 - 29.99) 36% 29% 32% 24% 16%

Obese (BMI 30.00+) 24% 36% 23% 14% 52%

Mean 26.90 28.21 27.51 24.73 29.56

Slightly more than one-third (35%) of residents said they have been advised by a doctor to lose weight at some point in the past. This number is virtually unchanged from 2012 when it was 34%.




Yes 38% 35% 21% 35% 31% No 61% 65% 78% 64% 68% Not sure - - - 1% 1%

Forty-five percent of residents said they are trying to lose weight now. That number is three percentage points higher than in 2012.

2014 Age Breakouts 18-34 35-49 50-64 65+

Yes 34% 51% 54% 37% No 66% 48% 46% 63% Not sure - - - -



Yes 45% 53% 34% 48% 37% No 55% 47% 66% 52% 63% Not sure - - - - 1%


2014 Gender Breakouts Male Female

Yes 37% 51% No 63% 49% Not sure - -

Fruit and Vegetable Consumption

Most Howard County resident (53%) said they eat one or two servings of fruit a day. Fourteen percent eat three or more servings a day, while 31% eat less than a serving of fruit a day. Overall, these numbers are very similar to 2012.


5 or more times per day 3% 2% 3% 1% 3% 3 but less than 5 times per day 14% 14% 12% 11% 9%

1 but less than 3 times per day 57% 57% 49% 50% 54%

Less than once per day or never 24% 26% 35% 33% 32%

Not sure 1% 1% - 5% 2%




5 or more times per day 3% 3% 1% 1% - 3 but less than 5 times per day 13% 12% 11% 2% 7%



Not sure 1% 1% 2% - 2%


$100,000- $149,999

$150,000- $199,999 $200,000+

5 or more times per day - 2% 3% 2% 4% 3 but less than 5 times per day 11% 12% 15% 11% 13%



Not sure/ Refused 1% 1% 2% 2% 2%


Degree Postgraduate

5 or more times per day 2% 2% 2% 3%

3 but less than 5 times per day 12% 11% 12% 14%


Less than once per day or never 42% 35% 29% 23%

Not sure 1% 2% 2% 1%






Not sure 2% 1% - 2% 1%


Fifty-eight percent of residents eat one or two servings of vegetables a day. Twelve percent eat three or more servings a day, while 29% eat less than one serving of vegetables per day. Like fruit consumption, these numbers are very similar to 2012.





Not sure - 1% 1% 4% 2%







Not sure 1% 1% 3% 1% 3%


$100,000- $149,999

$150,000- $199,999 $200,000+




Not sure 1% 1% 2% 1% 1%


Degree Postgraduate

5 or more times per day 3% 3% 2% 3% 3 but less than 5 times per day 7% 9% 9% 10%


Less than once per day or never 35% 36% 28% 20%

Not sure 1% 2% 1% 1%






Not sure 2% 1% 1% 1% 2%


An index of fruit and vegetable consumption can be calculated from these survey responses by combining the servings of fruit and the servings of vegetables that each survey respondent reported. Through this means, it can be identified that 99% of Howard County residents consume at least some fruits and vegetables. The vast majority of residents (81%) consume less than five servings daily, while 18% consume five or more servings of fruits and vegetables on a typical day. These numbers have not changed significantly since 2012.


None 1% - 0 to less than 5 servings/day 84% 78% 5 or more servings/day 14% 22% Median 2.00 2.71

2014 Age Breakouts 18-34 35-49 50-64 65+

None 1% - 1% - 0 to less than 5 servings/day 79% 81% 80% 87% 5 or more servings/day 20% 19% 18% 13% Median 2.29 2.57 2.14 2.00


$100,000- $149,999

$150,000- $199,999 $200,000+

None 1% 2% 1% 3% 3% 0 to less than 5 servings/day 86% 7% 10% 12% 7% 5 or more servings/day 13% 1% 2% 1% 1% Median 2.00 2.00 2.43 3.00 2.86


Physical Activity

In the week prior to the survey, 81% of residents did physical activities for exercise, such as running, golf, swimming, yard work, or walking. This question was not asked in 2012.


Yes 86% 79% 82% 75% 82% No 14% 21% 18% 25% 18% Not sure - - - - -


Yes 82% 79% No 18% 20% Not sure - -

2014 Age Breakouts 18-34 35-49 50-64 65+

Yes 77% 86% 84% 73% No 23% 14% 16% 27% Not sure - - - -




Yes 82% 76% 84% 83% 67% No 18% 24% 16% 17% 33% Not sure - - - - -


$100,000- $149,999

$150,000- $199,999 $200,000+

Yes 69% 81% 82% 83% 91% No 31% 19% 18% 17% 9% Not sure - - - - -


Degree Postgraduate

Yes 73% 77% 81% 88% No 27% 23% 19% 12% Not sure - - - -

2014 Parent Breakouts Has Children No Children

Yes 84% 78% No 16% 22% Not sure - -


Among those who said they had taken part in physical exercise during the prior week, the average (mean) number of times was 4.53.


Keeping in mind that the interviews were collected in the summer, most residents (73%) exercised outdoors, followed by at home (25%), or at a membership club (24%).


Outside 69% 71% 78% 75% 70% In your home or friend's home 30% 27% 22% 23% 24%

At your housing clubhouse 3% 2% 5% 2% 2%

At work 5% 3% 6% 7% 3%

At a membership club 24% 27% 23% 22% 24%

Somewhere else 5% 8% 6% 3% 3%

Not sure - - - - -


In the week prior to the survey, 43% of residents did physical activities to strengthen their muscles. This question was not asked in 2012.


Yes 49% 43% 40% 43% 46% No 51% 57% 59% 57% 54% Not sure - 1% - - -


Yes 47% 40% No 52% 60% Not sure - -

2014 Age Breakouts 18-34 35-49 50-64 65+

Yes 50% 44% 41% 35% No 49% 56% 59% 65% Not sure 1% - - -



Degree Postgraduate

Yes 30% 44% 46% 49% No 69% 56% 53% 50% Not sure - - - -


$100,000- $149,999

$150,000- $199,999 $200,000+

Yes 30% 45% 41% 55% 54% No 70% 55% 58% 45% 46% Not sure - 1% - - -

Among those who said they had taken part in physical activities or exercise to strengthen their muscles during the prior week, the average (mean) number of times was 3.32.


Residents were most likely to undertake strengthening exercises at home (54%) or at a membership club (41%).


Outside 9% 18% 13% 14% 10%

In your home or friend's home 56% 54% 52% 59% 49%

At your housing clubhouse 3% 5% 4% 2% 3%

At work 4% - 4% 6% 4%

At a membership club 38% 42% 41% 37% 44%

Somewhere else 6% 7% 7% 1% 3%

Not sure - - - - -


Sugary Drinks

Forty-two percent of Howard County residents consume regular soda on at least an occasional basis. Eight percent said they consume soda daily, another 15% between two and six times a week, and 20% drink soda no more often than once a week. Different answer categories in 2012 make trend data not comparable between 2012 and 2014 for this series of questions.

2014 Age Breakouts 18-34 35-49 50-64 65+

Daily (1+drinks/ day) 9% 8% 7% 7% 2-6 drinks/week 21% 15% 12% 7% 1/week or fewer 24% 22% 17% 12% None/ Never/ Rarely 46% 55% 64% 74% Not sure - - 1% -



Daily (1+drinks/ day) 9% 7% 5% 6% 5% 2-6 drinks/week 12% 22% 17% 21% 19% 1/week or fewer 16% 18% 32% 23% 36% None/ Never/ Rarely 63% 52% 44% 50% 40% Not sure - - 1% - -


2014 Employment Status Breakouts

Employed Self-Employed Unemployed Retired Other


Twenty-three percent of residents consume sports drinks like Gatorade or Powerade at least occasionally. Four percent drink them daily, 6% between two and six times a week, and 13% no more often than once a week.


Daily (1+drinks/ day) 5% 3% 3% 5% 5% 2-6 drinks/week 11% 3% 6% 6% 7% 1/week or fewer 13% 13% 12% 13% 14% None/ Never/ Rarely 71% 81% 79% 75% 74% Not sure - - - - -


2014 Age Breakouts 18-34 35-49 50-64 65+

Daily (1+drinks/ day) 7% 4% 2% 1% 2-6 drinks/week 10% 7% 3% 2% 1/week or fewer 21% 13% 9% 5% None/ Never/ Rarely 62% 76% 86% 92% Not sure - - - -




Forty-one percent of residents at least occasionally consume other kinds of sugary beverages such as fruit drinks like Snapple and cranberry juice cocktail, flavored teas and waters, and energy drinks like Red Bull and Monster. Fifteen percent drink them daily, another 15% between two and six times a week, and 12% drink them once a week or less often.



Daily (1+drinks/ day) 14% 13% 13% 13% 23% 2-6 drinks/week 12% 16% 14% 16% 17% 1/week or fewer 12% 9% 13% 14% 10% None/ Never/ Rarely 60% 62% 59% 57% 49% Not sure/ Refused 2% - 1% - 1%

2014 Age Breakouts 18-34 35-49 50-64 65+

Daily (1+drinks/ day) 16% 14% 16% 13% 2-6 drinks/week 24% 15% 8% 9% 1/week or fewer 15% 14% 10% 6% None/ Never/ Rarely 44% 57% 66% 71% Not sure/ Refused 2% - - 1%



Daily (1+drinks/ day) 11% 27% 11% 17% 17% 2-6 drinks/week 13% 23% 16% 20% 24% 1/week or fewer 11% 14% 14% 6% 10% None/ Never/ Rarely 64% 36% 58% 57% 44% Not sure/ Refused - - 1% - 1%



Daily (1+drinks/ day) 14% 13% 13% 14% 18% 2-6 drinks/week 16% 9% 36% 7% 13% 1/week or fewer 13% 11% 9% 5% 13% None/ Never/ Rarely 56% 65% 39% 72% 55% Not sure/ Refused 1% 2% 3% 1% 1%


According to parents, 38% of their children drink regular soda. Parents said that 3% of their children drink soda at least daily, 13% drink between two and six servings of soda per week, and 21% drink soda once a week or less often.


Degree Postgraduate

Daily (1+drinks/ day) 4% 3% 4% 2% 2-6 drinks/week 18% 13% 15% 9% 1/week or fewer 24% 21% 18% 23% None/ Never/ Rarely 44% 58% 59% 64% Not sure/ Refused 10% 2% 2% -


Thirty-six percent of children drink sports drinks like Gatorade or Powerade. Five percent drink them daily, 13% between two and six times per week, and 17% once a week or less.




$100,000- $149,999

$150,000- $199,999 $200,000+



According to parents, nearly two-thirds (62%) of their youngest children between the ages of two and 18 drink fruit drinks like cranberry juice cocktail, Capri Sun, Sunny D, Hi-C, Kool-Aid, or Hawaiian Punch. More than one in four of these children (27%) drink those kinds of fruit drinks every day. Another 23% drink them two to six times per week, and 13% drink them once a week or less.





$100,000- $149,999

$150,000- $199,999 $200,000+



In the month prior to the survey, 49% of survey respondents had bought a sugar sweetened beverage for their family to drink at home, including regular soda, sports drinks like Gatorade or Powerade, fruit drinks like Capri Sun or Hawaiian Punch, energy drinks, or sweetened teas and waters.

2014 Age Breakouts 18-34 35-49 50-64 65+

Yes 48% 63% 45% 28% No 51% 37% 55% 71% Not sure 1% - - -



Yes 54% 49% 67% 30% 45% No 46% 51% 33% 70% 53% Not sure - - - - 3%


Behavioral Health The Behavioral Health section includes questions about residents’ mental health condition, financial worry, access to mental health treatment, tobacco use, and alcohol use. Mental Health

Seven percent of residents in 2014 said they were presently taking medicine or receiving treatment from a health professional for a mental health condition or emotional problem. This is a slight decrease from the 9% who said so in 2012.


Yes 5% 4% 11% 6% 7% No 95% 96% 88% 94% 92% Not sure - - 1% - -



Yes 8% 8% - 8% 3% No 92% 91% 100% 92% 97% Not sure - 1% - - -




Yes 5% 6% 16% 6% 15% No 95% 94% 80% 93% 85% Not sure - - 4% - -

One-quarter (26%) of Howard County residents said they worried at least sometimes in the prior 12 months about having enough money to pay vital expenses like your rent, mortgage, or food. Four percent said they “always” worried about that, 5% said they “usually did,” and 17% said they worried “sometimes.” The percentage who said they “never” worried declined slightly from 54% in 2012 to 51% in 2014.


Always 3% 2% 6% 5% 5% Usually 2% 3% 6% 7% 7% Sometimes 14% 16% 20% 18% 16% Rarely 21% 23% 20% 22% 21% Never 59% 56% 46% 47% 51% Not applicable - - 1% 1% - Not sure - 1% - - -



American Asian Hispanic Others

Always 3% 8% 1% 4% 9% Usually 4% 7% 6% 11% 16% Sometimes 15% 23% 16% 28% 22% Rarely 23% 19% 19% 23% 14% Never 53% 42% 57% 28% 38% Not applicable - - 1% 6% - Not sure - - - - -


$100,000- $149,999

$150,000- $199,999 $200,000+

Always 11% 5% 2% 1% 1% Usually 11% 5% 3% 4% - Sometimes 34% 20% 15% 5% 7% Rarely 17% 25% 27% 20% 16% Never 25% 44% 52% 67% 76% Not applicable - - - 3% - Not sure 1% - - - -


Degree Postgraduate

Always 8% 6% 3% 2% Usually 9% 7% 4% 2% Sometimes 22% 23% 15% 13% Rarely 19% 24% 24% 18% Never 39% 38% 54% 65% Not applicable - 2% - - Not sure 1% - - -



Unmarried Couple

Always 3% 10% 2% 6% 18% Usually 4% 11% 6% 6% 2% Sometimes 15% 24% 24% 18% 44% Rarely 22% 20% 18% 20% 15% Never 56% 35% 42% 48% 21% Not applicable - - 2% 2% - Not sure/ Refused - - 5% - -


Three percent of residents said there was a time during the prior 12 months when they needed mental health treatment or counseling but did not get it.


Degree Postgraduate

Yes 3% 5% 2% 2% No 97% 94% 98% 97% Not sure - - - -



Yes 2% 2% 9% - 7% No 98% 98% 91% 99% 93% Not sure - - - - -


Residents who did not receive the mental health treatment they felt they needed cited cost concerns (22%), lack of time (14%), trepidation (12%), a conviction that they could overcome the problem themselves (11%), a provider that was too busy to see them (8%), their own laziness or procrastination (7%), transportation limitations (7%), or a lack of certainty how or where to seek those services (3%).


Tobacco

Twenty-nine percent of residents said they have smoked at least 100 cigarettes in their life, a common measure of smoking behavior. This percentage is slightly larger than the 27% measured in 2012.



Yes 33% 27% 12% 34% 30% No 67% 73% 88% 66% 68% Not sure - - - - 2%


$100,000- $149,999

$150,000- $199,999 $200,000+

Yes 36% 39% 25% 22% 22% No 63% 61% 75% 78% 78% Not sure 1% - - - -


Degree Postgraduate

Yes 41% 37% 27% 17% No 58% 63% 73% 83% Not sure 1% - - -




Unmarried Couple

Yes 29% 46% 41% 16% 50% No 71% 54% 59% 83% 46% Not sure - - - 1% 4%

Fifteen percent of people who have smoked at least 100 cigarettes in their life said they now smoke every day; an additional 11% said they smoke “some days.” This aggregate 26% is slightly lower than the 29% measured in 2012, when 20% of lifetime smokers said they currently smoked every day. Projected over the full adult population of Howard County, the smoking rate in 2014 is 7.5%, compared to 7.9% in 2012.

2014 Age Breakouts 18-34 35-49 50-64 65+

Every day 17% 14% 27% 4% Some days 23% 15% 6% 4% Not at all 60% 71% 68% 92% Not sure - - - -


$100,000- $149,999

$150,000- $199,999 $200,000+

Every day 21% 22% 8% 11% 5% Some days 21% 9% 14% 2% 7% Not at all 58% 69% 79% 87% 88% Not sure - - - - -



Degree Postgraduate

Every day 23% 19% 11% 5% Some days 10% 17% 9% 7% Not at all 67% 64% 80% 87% Not sure - 1% - -



Every day 16% 17% 27% 9% 19% Some days 9% 15% 22% 4% 23% Not at all 75% 66% 51% 87% 58% Not sure - 2% - - -



Unmarried Couple

Every day 11% 28% 15% 18% 29% Some days 6% 19% 3% 23% 47% Not at all 83% 53% 82% 59% 24% Not sure - - - - -

There is negligible use of chewing tobacco, snuff, or snus in Howard County. In 2014, those who said they used these tobacco products every day and some days each rounded to zero; together, those two categories amounted to about 1% of the survey sample.


Two percent of residents said they use e-cigarettes some days. The number who said they use them every day was very small – less than one-half percent.

2014 Age Breakouts 18-34 35-49 50-64 65+

Every day 1% - - - Some days 5% 1% 1% 1% Not at all 95% 98% 99% 99% Not sure - - - -


$100,000- $149,999

$150,000- $199,999 $200,000+

Every day - 1% 1% 1% - Some days 5% 2% 1% 2% 1% Not at all 95% 97% 99% 98% 99% Not sure - - - - -


Ninety-seven percent of residents said that no one else had smoked inside their home while they are at home during the previous seven days. Two percent said someone else smoked inside the home every day, and 1% said someone did that one or two days that week. Those numbers are virtually unchanged from 2012.


$100,000- $149,999

$150,000- $199,999 $200,000+

None 93% 97% 98% 99% 99% Rarely (1-2 days) 2% 1% 1% - - Frequently (3-6 days) - - - - - Every day (7 days) 4% 2% 1% 1% - Not sure - - - - -


Degree Postgraduate

None 93% 96% 98% 99% Rarely (1-2 days) 3% 1% 1% 1% Frequently (3-6 days) - - - - Every day (7 days) 3% 3% 1% - Not sure 2% - - -




None 98% 96% 87% 95% 95% Rarely (1-2 days) 1% - 5% 1% 3% Frequently (3-6 days) - - - - - Every day (7 days) 1% 4% 2% 4% 2% Not sure - - 6% - -

Ninety-six percent of residents said that they did not ride in a vehicle during the previous week in which someone else was smoking. One percent said they rode with someone every day who smoked in the vehicle, and 2% said they rode with someone else smoked one or two days during the prior week. These numbers show a slight improvement from the 2012 survey.


$100,000- $149,999

$150,000- $199,999 $200,000+

None 90% 97% 98% 99% 97% Rarely (1-2 days) 9% 1% 1% 1% 1% Frequently (3-6 days) 1% 1% - - - Every day (7 days) 1% 1% - - 1% Not sure - - - - -



Degree Postgraduate

None 93% 94% 97% 99% Rarely (1-2 days) 3% 6% 2% 1% Frequently (3-6 days) 1% - 1% - Every day (7 days) 2% - - - Not sure - - - -



None 98% 96% 83% 99% 94% Rarely (1-2 days) 1% 2% 13% - 6% Frequently (3-6 days) 1% 1% - - - Every day (7 days) - 1% 5% 1% - Not sure - - - - -

Among residents of multi-family buildings, 14% said they can smell cigarette, cigar, or pipe tobacco smoke in their home from a neighbor. This is an improvement from the 23% who said so in 2012. In 2014, 3% said they could smell a neighbor’s smoke every day, another 3% said every couple of days, 5% said once a week, and 3% said once a month.



Every day - 2% 4% 1% 2% Every couple of days - 3% 4% - 2% Once a week 2% 2% 7% 2% 4% Once a month 4% 3% 3% 4% 2% Never 94% 91% 81% 93% 89% Not sure - - - - -


Degree Postgraduate

Every day 4% 1% 3% 4% Every couple of days 3% 2% 4% 3% Once a week 5% 2% 5% 7% Once a month 3% 3% 3% 3% Never 86% 93% 85% 83% Not sure - - - -



Every day 3% 2% 1% 1% 4% Every couple of days 2% 14% 10% - 1% Once a week 4% 16% 13% 2% 5% Once a month 3% 20% 1% - 2% Never 88% 49% 75% 96% 89% Not sure - - - - -


Alcohol Consumption

Forty percent of residents in the 2014 survey said they consumed no alcoholic drinks in the previous 30 days, an increase of two percentage points compared to 2012. Another 22% in 2014 said they consumed less than one alcoholic drink per week. Three percent said they drank and alcoholic beverage at least daily.



None 31% 50% 68% 29% 40%

1-3 days/month 23% 22% 13% 35% 19% 1 day/week or 4-6 days/month 15% 11% 5% 10% 17%

2 days/week or 7-10 days/month 11% 6% 2% 6% 3%




6 days/week or 24-27 days/month 2% 1% 1% 2% -

7 days/week or 28-31 days/month 4% 1% 1% - 1%

Not sure - 2% 2% 1% 2%



$100,000- $149,999

$150,000- $199,999 $200,000+

None 55% 38% 35% 34% 28%

1-3 days/month 18% 24% 24% 22% 23%

1 day/week or 4-6 days/month 12% 13% 13% 11% 18%







Not sure - 2% 1% 1% 1%


Degree Postgraduate

None 58% 41% 33% 35%

1-3 days/month 18% 24% 23% 22% 1 day/week or 4-6 days/month 8% 11% 15% 14%

2 days/week or 7-10 days/month 6% 7% 11% 9%






Not sure - 1% 1% 1%


One-quarter (26%) of Howard County residents had engaged in at least one episode of binge drinking in the past 30 days, defined as at least five drink on a single occasion for men, and four drinks for women. Three percent of residents had engaged in binge drinking at least five times during the prior month. These numbers are very similar to the 2012 survey, when 24% had engaged in binge drinking at least once during the prior month.


None 77% 74% 72% 67% 65% 1-2 12% 21% 18% 21% 22% 3-4 7% 1% 6% 3% 9% 5 or more 4% 2% 2% 9% 3% Not sure/ Refused 1% 1% 2% - 1%

2014 Age Breakouts 18-34 35-49 50-64 65+

None 49% 76% 77% 91% 1-2 34% 17% 13% 3% 3-4 8% 5% 4% 1% 5 or more 7% 1% 4% 1% Not sure 1% 1% 1% 3%



$100,000- $149,999

$150,000- $199,999 $200,000+

None 68% 65% 70% 76% 84% 1-2 18% 24% 23% 15% 11% 3-4 8% 7% 4% 5% 2% 5 or more 2% 4% 2% 3% 2% Not sure 4% 1% 1% - 1%


Degree Postgraduate

None 57% 66% 69% 83% 1-2 26% 23% 19% 13% 3-4 11% 6% 5% 2% 5 or more 5% 5% 4% 1% Not sure 1% - 3% -


Chronic Disease The Chronic Disease section includes questions on high blood pressure, cholesterol, asthma, COPD, diabetes, health problems requiring special equipment, and in-home care. One-quarter (24%) of Howard County residents have been told by a health professional that they have high blood pressure. Another 1% are women who were only told that during pregnancy, and 2% were told they were borderline high or pre-hypertensive. These numbers are unchanged since 2012.



Yes 26% 26% 12% 7% 17% Yes, but female told only during pregnancy 1% 1% 1% - 1%

No 71% 70% 86% 89% 77% Told borderline high or pre-hypertensive 1% 3% 1% 4% 5%

Not sure/ Refused - - - - -




Unmarried Couple

Yes 24% 33% 55% 10% 43% Yes, but female told only during pregnancy 1% - 1% - -

No 73% 65% 42% 88% 48% Told borderline high or pre-hypertensive 2% 3% 1% 1% 9%

Not sure/ Refused - - 2% - -



Yes 18% 21% 36% 60% 11% Yes, but female told only during pregnancy 1% - - - 1%

No 79% 78% 58% 37% 87% Told borderline high or pre-hypertensive 2% - 6% 2% 1%

Not sure - - - - -


Of those who have been told they have high blood pressure, 81% are currently taking medication to help control it.

2014 Age Breakouts 18-34 35-49 50-64 65+

Yes 38% 72% 79% 96% No 62% 28% 21% 4% Not sure - - - -



Unmarried Couple

Yes 80% 85% 93% 64% 86% No 20% 15% 7% 36% 14% Not sure - - - - -


Eighty-five percent can remember having their blood cholesterol checked. Thirteen percent feel certain that their cholesterol has not been checked, while 2% are not sure. In 2012, a somewhat higher 89% recalled a blood cholesterol check at some point in the past.


Yes 87% 85% 89% 78% 84% No 12% 11% 9% 22% 15% Not sure 2% 5% 2% 1% 1%



Yes 88% 81% 75% 80% 84% No 10% 17% 20% 20% 16% Not sure 2% 3% 5% - -


$100,000- $149,999

$150,000- $199,999 $200,000+

Yes 83% 90% 90% 82% 90% No 16% 7% 10% 16% 8% Not sure 1% 3% - 2% 2%



Degree Postgraduate

Yes 79% 78% 86% 93% No 17% 20% 12% 6% Not sure 5% 2% 1% 1%

For those who could remember a cholesterol test, 78% said it was within the past year, 13% said the test was between one and two years ago, 6% said it was between two and five years ago, and 2% said it was five or more years in the past. The number who remembered having a cholesterol test within the past year increased by three percentage points between 2012 and 2014.

2014 Age Breakouts 18-34 35-49 50-64 65+

Within the past year 75% 71% 84% 90%

1 year but less than 2 years ago 14% 19% 9% 4%



Not sure 2% 1% 1% 2%






5 or more years ago 2% 2% 1% - 1%

Not sure 1% - 6% - -


Degree Postgraduate




Not sure 2% - 2% 1%



Within the past year 75% 71% 95% 91% 75%

1 year but less than 2 years ago 15% 21% 2% 3% 14%


5 or more years ago 2% 1% - 1% 2%

Not sure 1% 4% - 2% 1%


One-third (33%) who could remember having a cholesterol test said they were told their blood cholesterol was high. There is no significant difference from the 32% measured in 2012.


Yes 41% 27% No 58% 72% Not sure 1% 1%



Yes 35% 31% 17% 31% 43% No 63% 69% 83% 69% 57% Not sure 1% - 1% - -


Degree Postgraduate

Yes 36% 34% 35% 30% No 62% 66% 65% 69% Not sure 2% - - 1%




Unmarried Couple

Yes 34% 45% 46% 19% 22% No 66% 55% 47% 81% 78% Not sure/ Refused - - 7% - -

Eleven percent of Howard County residents have asthma. In 2012, through a slightly different question, 9% said they have asthma.

2014 Age Breakouts 18-34 35-49 50-64 65+

Yes 16% 9% 12% 6% No 83% 91% 88% 93% Not sure 1% - - -



Yes 9% 14% 12% 33% 30% No 90% 86% 87% 67% 70% Not sure - - 1% - -



$100,000- $149,999

$150,000- $199,999 $200,000+

Yes 18% 11% 9% 13% 8% No 82% 88% 91% 87% 92% Not sure - - - - -

Three percent of residents said they have been told they have chronic obstructive pulmonary disease (COPD), emphysema, or chronic bronchitis. This is nearly identical to the 4% who said they had one of these diseases in 2012.


$100,000- $149,999

$150,000- $199,999 $200,000+

Yes 6% 2% 1% 1% 1% No 93% 97% 98% 99% 99% Not sure 1% - 1% - -



Yes 2% 2% 11% 7% 2% No 98% 98% 89% 93% 98% Not sure - - - - -




Unmarried Couple

Yes 2% 7% 9% 2% 3% No 98% 93% 91% 98% 97% Not sure - - - - -

Diabetes

Eight percent of residents have been told they have diabetes. An additional 4% volunteered that they were told they had pre-diabetes or borderline diabetes.

2014 Age Breakouts 18-34 35-49 50-64 65+

Yes 1% 5% 10% 24%

No 94% 92% 84% 72% No, pre-diabetes or borderline diabetes 4% 3% 5% 2%

Not sure / Refused - - - 1%



$100,000- $149,999

$150,000- $199,999 $200,000+

Yes 13% 9% 8% 6% 2%

No 85% 85% 86% 92% 94%

No, pre-diabetes or borderline diabetes 1% 5% 6% 2% 4%

Not sure/ Refused 1% - - - -



Yes 5% 5% 9% 25% 4%

No 90% 92% 89% 73% 93% No, pre-diabetes or borderline diabetes 4% 4% 2% 2% 3%

Not sure/ Refused - - - - -



Unmarried Couple

Yes 8% 11% 15% 3% 23%

No 87% 86% 81% 93% 77% No, pre-diabetes or borderline diabetes 4% 2% 3% 4% -

Not sure/ Refused - - 2% - -


Of those who have not been told they have diabetes, 8% have been told they have pre-diabetes or borderline diabetes. This is a slight increase from the 6% measured in 2012. Another 1% in both 2014 and 2012 said that was only while they were pregnant.


$100,000- $149,999

$150,000- $199,999 $200,000+

Yes 6% 12% 10% 8% 5% Yes, during pregnancy 2% 2% 1% 1% 1% No 88% 86% 89% 91% 94% Not sure/ Refused 4% 1% 1% - -



Unmarried Couple

Yes 7% 6% 20% 8% 5% Yes, during pregnancy 2% 4% 1% - - No 91% 88% 76% 90% 95% Not sure/ Refused - 1% 3% 2% -


Based on their recollection, on average residents were 45 years old when they were first told they had diabetes. In 2012, a slightly higher average age of 50 was recorded.


Less than 40 14% 23% 19% 19% 24% 40-49 7% 20% 48% 40% 19% 50-59 30% 15% 16% 20% 41% 60+ 42% 24% 10% 21% 10% Not sure 7% 18% 6% - 7%



Less than 40 20% 15% 18% 45% 27% 40-49 18% 59% 54% 31% 10% 50-59 27% 16% 13% 24% 27% 60+ 29% 3% 16% - 6% Not sure 6% 7% - - 30%



$100,000- $149,999

$150,000- $199,999 $200,000+

Less than 40 11% 27% 23% 26% 8% 40-49 38% 20% 27% 33% 22% 50-59 24% 21% 30% 5% 70% 60+ 15% 28% 17% 17% - Not sure 12% 3% 2% 19% -

Ninety percent of residents who have been told they have diabetes said they are now taking insulin or other medicine to help with the disease.

2014 Age Breakouts 18-34 35-49 50-64 65+

Yes 100% 89% 86% 93% No - 11% 14% 7% Not sure - - - -



Yes 91% 94% 64% 69% 100% No 9% 6% 36% 31% - Not sure - - - - -


In the 2014 survey, residents with diabetes said they had seen a health professional for their diabetes an average of 2.37 times in the prior 12 months. In 2012, the average was a very similar 3.35 visits.


None 5% 6% 1 17% 5% 2 24% 20% 3 20% 13% 4 21% 46% 5+ 11% 9% Not sure 2% 1%

2014 Age Breakouts 18-34 35-49 50-64 65+

None - - 8% 7% 1 - 11% 23% 6% 2 - 27% 11% 30% 3 - 19% 15% 19% 4 63% 32% 31% 30% 5+ 37% 11% 13% 6% Not sure - - - 3%




None 1% - 45% 6% 3% 1 12% - 9% 5% 58% 2 20% 10% - 31% 7% 3 11% 36% 10% 26% - 4 41% 54% 23% 28% 6% 5+ 12% - 13% 4% 26% Not sure 2% - - 1% -

Residents with diabetes received the A1C test an average of 2.85 times over the prior 12 months, according to the 2014 survey. Seven percent of respondents said they had not heard of the test. In 2012, the average was slightly higher at 3.13 times in the prior 12 months.


2014 Age Breakouts 18-34 35-49 50-64 65+

None - - 21% 1% 1 - 22% 5% 18% 2 - 25% 11% 34% 3 17% 23% 9% 13% 4 83% 28% 34% 23% 5+ - 2% 16% 5% Not sure - - 4% 6% Never heard of A1C test - - - -



None 2% 13% - - 30% 1 13% 3% 13% 69% 45% 2 22% 39% 16% - 7% 3 16% 8% 18% 31% 8% 4 37% 19% 40% - 10% 5+ 5% 18% - - - Not sure 4% - 13% - - Never heard of A1C test - - - - -


$100,000- $149,999

$150,000- $199,999 $200,000+

None 19% 1% 3% - - 1 14% 21% 13% 20% - 2 29% 9% 21% 49% 42% 3 2% 26% 12% 14% - 4 26% 39% 41% 9% 58% 5+ 8% 3% 3% 8% - Not sure 2% - 6% - - Never heard of A1C test - - - - -


Special Equipment/ Special Care

Five percent of residents said they have a health problem that requires them to use special equipment such as a cane, a wheelchair, a special bed, or a special telephone. In 2012, 4% of residents said they required special equipment.

2014 Age Breakouts 18-34 35-49 50-64 65+

Yes 1% 3% 4% 16% No 99% 97% 96% 84% Not sure - - - -


$100,000- $149,999

$150,000- $199,999 $200,000+

Yes 11% 5% 2% 2% 2% No 89% 95% 98% 98% 98% Not sure - - - - -



Yes 1% 3% 10% 18% 6% No 99% 97% 90% 82% 94% Not sure - - - - -




Unmarried Couple

Yes 3% 4% 27% 4% 5% No 97% 96% 73% 96% 95% Not sure - - - - -

Three percent have someone living with them who requires special in-home case. In 2012, the number was 4%.


Other Issues The Other Issues section includes a question on Lyme Disease. Fifty-seven percent of residents said they are taking protective measures against ticks when they go outside such as wearing protective clothing, finding and removing ticks, or avoiding wooded and bushy areas. This number is down significantly from the 66% measured in 2012.


Yes 64% 55% 57% 53% 54% No 36% 44% 42% 47% 46% Not sure/ Refused - - 1% - -

2014 Age Breakouts 18-34 35-49 50-64 65+

Yes 56% 63% 53% 50% No 44% 37% 46% 49% Not sure/ Refused - 1% - 1%




Yes 62% 49% 42% 52% 50% No 37% 51% 58% 47% 50% Not sure - - - 1% -


Appendix:

Survey Instrument


Hello, I am calling for the Howard County Health Department. My name is ______________. We are gathering information about the health of County residents. This project is being conducted by the health department following Centers for Disease Control and Prevention guidelines. Your telephone number has been chosen randomly, and I would like to ask some questions about health and health practices. To ensure we are speaking to a representative group of residents may I please speak to the youngest male age 18 or older who is at home right now? IF NO: May I please speak to the youngest female in the household age 18 or older who is at home? I will not ask for your last name, address, or other personal information that can identify you. You do not have to answer any question you do not want to, and you can end the interview at any time. Any information you give me will be confidential. If you have any questions about the survey, please call 410-280-3100. S1. Just to confirm, do you live in Howard County?

1 Yes 2 No (Thank and terminate.) 9 Not sure/Refused to say (Thank and terminate.)

S2. In what zip code do you live? (Record 5-digit zip.)

20701 20723 20759 20763 20777 20794 20833 21029 21036 21041

21042 21043 21044 21045 21046 21075 21076 21104 21150 21163

21723 21737 21738 21765 21771 21784 21794 21797

8.22 I am required to ask this question. So that we have a balanced sample, what is your gender? (Note: Answer drives skip patterns for Q.4.1, 6.1, M01.2.) (151) 1 Male 2 Female 3 Transgender C03 Health Care Access (general) 3.1 Do you have any kind of health care coverage, including health insurance, prepaid plans such as HMOs, or government plans such as Medicare or Indian Health Services? (80) 1 Yes 2 No 7 Don‘t know / Not sure 9 Refused


3.2 Do you have one person you think of as your personal doctor or health care provider? If “No,” ask: “Is there more than one, or is there no person who you think of as your personal doctor or health care provider?” (81) 1 Yes, only one 2 More than one 3 No 7 Don‘t know / Not sure 9 Refused 3.3 Was there a time in the past 12 months when you needed to see a doctor but could not because of cost? (82) 1 Yes 2 No 7 Don‘t know / Not sure 9 Refused 3.3A When you are sick or need medical attention, to which one of the following places do you usually go? Would you say: Please read: 1 A doctor's office 2 A community health center like Chase Brexton 4 A hospital emergency room 5 An urgent care center like Patient First or Minute Clinic 6 Some other kind of place Or 8 No usual place Do not read: 7 Don’t know / Not sure 9 Refused 3.3B Thinking about your most recent visit to your primary health care provider for a medical issue you wanted resolved quickly, how long did you have to wait between when the appointment was made and when the appointment actually occurred? Do not read: 1 Same day 2 Within 2-3 days 3 Within 1 week 4 Within 1 month 5 Longer than 1 month 6 Does not apply to me 7 Don’t know / Not sure 9 Refused 3.3C Was there a time in the past 12 months when you needed to go to the emergency room because you could not get a timely appointment with a doctor? 1 Yes 2 No 7 Don’t know / Not sure 9 Refused


C04 Hypertension 4.1 Have you EVER been told by a doctor, nurse, or other health professional that you have high blood pressure? (84) Read only if necessary: By “other health professional” we mean a nurse practitioner, a physician‘s assistant, or some other licensed health professional. If “Yes” and respondent is female, ask: “Was this only when you were pregnant?” 1 Yes 2 Yes, but female told only during pregnancy [Go to next section] 3 No [Go to next section] 4 Told borderline high or pre-hypertensive [Go to next section] 7 Don‘t know / Not sure [Go to next section] 9 Refused [Go to next section] 4.1A Are you currently taking medication to help with your high blood pressure? 1 Yes 2 No 7 Don‘t know / Not sure 9 Refused C05 High Cholesterol 5.1 Blood cholesterol is a fatty substance found in the blood. Have you ever had your blood cholesterol checked? (86) 1 Yes 2 No [Go to next section] 7 Don‘t know / Not sure [Go to next section] 9 Refused [Go to next section] 5.2 About how long has it been since you last had your blood cholesterol checked? (87) Read only if necessary: 1 Within the past year (anytime less than 12 months ago) 2 Within the past 2 years (1 year but less than 2 years ago) 3 Within the past 5 years (2 years but less than 5 years ago) 4 5 or more years ago Do not read: 7 Don‘t know / Not sure 9 Refused 5.3 Have you ever been told by a doctor, nurse or other health professional that your blood cholesterol is high? (88) 1 Yes 2 No 7 Don‘t know / Not sure 9 Refused


C06 Chronic Health Conditions: Now I would like to ask you some questions about general health conditions. Has a doctor, nurse, or other health professional ever told you that you had any of the following? For each, tell me “Yes,” “No,” or you‘re “not sure.” 6.5 Do you currently have asthma? (93) 1 Yes 2 No 7 Don‘t know / Not sure 9 Refused C06 COPD 6.8 (Ever told) you have (COPD) chronic obstructive pulmonary disease, emphysema (em-fiz-ZEE-muh) or chronic bronchitis (bron-KITE-us)? (96) 1 Yes 2 No 7 Don‘t know / Not sure 9 Refused C06 Diabetes 6.13 (Ever told) you have diabetes? (101) (If “Yes” and respondent is female, ask): “Was this only when you were pregnant?” If respondent says pre-diabetes or borderline diabetes, use response code 4. 1 Yes 2 Yes, but female told only during pregnancy 3 No 4 No, pre-diabetes or borderline diabetes 7 Don‘t know / Not sure 9 Refused M01 Pre-Diabetes NOTE: Only asked of those not responding “Yes” (code = 1) to Core Q6.13 (Diabetes awareness question). CATI NOTE: If Core Q6.13 = 4 (No, pre-diabetes or borderline diabetes); answer Q2 “Yes” (code = 1). M01.2. Have you ever been told by a doctor or other health professional that you have pre-diabetes or borderline diabetes? (246) If “Yes” and respondent is female, ask: “Was this only when you were pregnant?” 1 Yes 2 Yes, during pregnancy 3 No 7 Don‘t know / Not sure 9 Refused


M02 Diabetes To be asked following Core Q6.13; if response is "Yes" (code = 1) M02.1. How old were you when you were told you have diabetes? (247-248) _ _ Code age in years [97 = 97 and older] 98 Don‘t know / Not sure 99 Refused M02.2. Are you now taking insulin or other medicine to help with your diabetes? (249) 1 Yes 2 No 9 Refused M02.5. About how many times in the past 12 months have you seen a doctor, nurse, or other health professional for your diabetes? (256-257) _ _ Number of times [76 = 76 or more] 88 None 77 Don‘t know / Not sure 99 Refused M02.6. A test for "A one C" measures the average level of blood sugar over the past three months. About how many times in the past 12 months has a doctor, nurse, or other health professional checked you for "A one C"? (258-259) _ _ Number of times [76 = 76 or more] 88 None 98 Never heard of ―A one C‖ test 77 Don‘t know / Not sure 99 Refused C07 Tobacco Use 7.1 Have you smoked at least 100 cigarettes in your entire life? (102) NOTE: 5 packs = 100 cigarettes 1 Yes 2 No [Go to Q7.5] 7 Don‘t know / Not sure [Go to Q7.5] 9 Refused [Go to Q7.5] 7.2 Do you now smoke cigarettes every day, some days, or not at all? (103) 1 Every day 2 Some days 3 Not at all 7 Don‘t know / Not sure 9 Refused


7.5 Do you currently use chewing tobacco, snuff, or snus every day, some days, or not at all? (Snus rhymes with “goose‟) NOTE: Snus (Swedish for snuff) is a moist smokeless tobacco, usually sold in small pouches that are placed under the lip against the gum. (107) 1 Every day 2 Some days 3 Not at all Do not read: 7 Don‘t know / Not sure 9 Refused 7.5A E-cigarettes are battery powered devices that provide inhaled doses of nicotine. Do you currently use e-cigarettes every day, some days, or not at all? 1 Every day 2 Some days 3 Not at all Do not read: 7 Don‘t know / Not sure 9 Refused C08 Demographics 8.1 What is your age? (108-109) _ _ Code age in years (18-97) 07 Don‘t know / Not sure 09 Refused 8.2 Are you Hispanic or Latino? (110) 1 Yes 2 No 7 Don‘t know / Not sure 9 Refused 8.3 Which one or more of the following would you say is your race? (111-116) (Code all that apply) Please read: 1 White 2 Black or African American 3 Asian 4 Native Hawaiian or Other Pacific Islander 5 American Indian or Alaska Native Or 6 Other [specify]______________ Do not read: 7 Don‘t know / Not sure 9 Refused


8.6 Are you…? (119) Please read: 1 Married 2 Divorced 3 Widowed 4 Separated 5 Never married Or 6 A member of an unmarried couple Do not read: 9 Refused 8.7A Have you ever served on active duty in the United States Armed Forces, either in the regular military or in a National Guard or military reserve unit? 1 Yes 2 No 9 Refused 8.7 How many children less than 18 years of age live in your household? (120-121) _ _ Number of children 88 None [Go to Q.8.8.] 99 Refused [Go to Q.8.8.] 8.7A1 (If children in home): Have you ever been told by a health care professional that your child should lose weight? 1 Yes 2 No 8.7A2 (If yes): What age were they at the time? Under 6, 6 to 10, 11 to 14, or 15 to 18? (Code all that apply; code only once for each age group even if multiple children in a single age group.) 1 Under 6 2 6 to 10 3 11 to 14 4 15 to 18 7 Don’t know / Not sure 9 Refused 8.8 What is the highest grade or year of school you completed? (122) Read only if necessary: 1 Never attended school or only attended kindergarten 2 Grades 1 through 8 (Elementary) 3 Grades 9 through 11 (Some high school) 4 Grade 12 or GED (High school graduate) 5 College 1 year to 3 years (Some college or technical school) 6 College 4 years (College graduate) 7 Graduate-level work or degree (More than 4 years college) Do not read: 9 Refused / Don’t know


8.9 Are you currently…? (123) Please read: 1 Employed for wages 2 Self-employed 3 Out of work for more than 1 year 4 Out of work for less than 1 year 5 A Homemaker 6 A Student 7 Retired Or 8 Unable to work Do not read: 9 Refused 8.10 Is your annual household income from all sources— (124-125) 1 Less than $50,000 per year (Do not read: $4,166 or less per month/ $961 or less per week) 2 $50,000 to $99,999 per year (Do not read: $8,333 – 4,167 per month/ $1,923 – 962 per week) 3 $100,000 to $149,999 per year (Do not read: $12,500 – 8,334 per month/ $2,884 – 1,924 per week) 4 $150,000 to $199,999 per year (Do not read: $12,501 – 16,666 per month/$2,885 – 3,846 per week) 5 $200,000 or more per year (Do not read: $16,667 or more per month/ $3,847 or more per week) Do not read: 7 Don‘t know / Not sure 9 Refused If respondent refuses at ANY income level, code 99 (Refused) 8.11 About how much do you weigh without shoes? (126-129) Round fractions up. _ _ _ _ Weight (pounds) 7777 Don‘t know / Not sure 9999 Refused 8.12 About how tall are you without shoes? (130-133) Round fractions down. _ _ / _ _ Height (ft / inches) 77/ 77 Don‘t know / Not sure 99/ 99 Refused 8.12A Have you ever been advised by your doctor to lose weight? 1 Yes 2 No 7 Don’t know / Not sure 9 Refused


8.12B Are you trying to lose weight now? 1 Yes 2 No 7 Don’t know / Not sure 9 Refused 8.21A Which of these best describes your home? Please read: 1 Single-family detached 2 Townhouse (Ask M16.5A) 3 Apartment, condo, or other multi-family building (Ask M16.5A) Do not read: 7 Don‘t know / Not sure 9 Refused 8.22A (Ask only in Columbia and Ellicott City planning areas): Do you live on property subject to the Columbia Association assessment? 1 Yes 2 No 7 Don‘t know / Not sure 9 Refused 8.22B (All): Do you currently have a membership with the Columbia Association? (If yes): Which one? Please read: 1 Pools only 2 Club only 3 Golf only 4 Tennis only 5 More than one, or a “package plan” Do not read: 6 No membership 7 Don‘t know / Not sure 9 Refused C09 Fruits and Vegetables These next questions are about the fruits and vegetables you ate or drank during the past 7 days. Please think about all forms of fruits and vegetables including cooked or raw, fresh, frozen or canned. Please think about all meals, snacks, and food consumed at home and away from home. I will be asking how often you ate or drank each one: for example, once a day, twice a week, and so forth. INTERVIEWER NOTE: If respondent responds less than once per week, put “0” times per week. If respondent gives a number without a time frame, ask: “Was that per day or per week?”


9.2R During the past week, not counting juice, how many times did you eat fruit? Count fresh, frozen, or canned fruit. (156-158) 1 _ _ Per day 2 _ _ Per week 555 Never 777 Don‘t know / Not sure 999 Refused Read only if necessary: “Your best guess is fine.” Read only if necessary: “Fruit includes apples, bananas, applesauce, oranges, grapefruit, fruit salad, watermelon, cantaloupe or musk melon, papaya, pomegranates, mangos, grapes, and berries such as blueberries and strawberries, and others.” INTERVIEWER NOTE: Do not count fruit jam, jelly, or fruit preserves. Do not include dried fruit in ready-to-eat cereals. Do include dried raisins, cran-raisins if respondent tells you - but due to their small serving size they are not included in the prompt. Do include cut up fresh, frozen, or canned fruit added to yogurt, cereal, jello, and other meal items. Include culturally and geographically appropriate fruits that are not mentioned. 9.4R During the past week, how many times did you eat vegetables that were not fried? Do not include rice or other grains. (162-164) 1 _ _ Per day 2 _ _ Per week 555 Never 777 Don‘t know / Not sure 999 Refused Read only if necessary: “Your best guess is fine.” INTERVIEWER NOTE: Each time a vegetable is eaten it counts as one time. Include all raw leafy green salads including spinach, mesclun, romaine lettuce, bok choy, dark green leafy lettuce, dandelions, komatsuna, watercress, and arugula. Do not include iceberg (head) lettuce if specifically told type of lettuce. Include all cooked greens including kale, collard greens, choys, turnip greens, mustard greens. Include all forms of carrots including long or baby-cut. Include carrot-slaw (e.g. shredded carrots with or without other vegetables or fruit). Include all forms of sweet potatoes including baked, mashed, casserole, pie, or sweet potatoes fries. Include all hard-winter squash varieties including acorn, autumn cup, banana, butternut, buttercup, delicate, hubbard, kabocha, and spaghetti squash. Include all forms including soup. Include pumpkin, including pumpkin soup and pie. Do not include pumpkin bars, cake, bread or other grain-based desert-type food containing pumpkin (i.e. similar to banana bars, zucchini bars). Include corn, peas, tomatoes, okra, beets, cauliflower, bean sprouts, avocado, cucumber, onions, peppers (red, green, yellow, orange); all cabbage including American-style cole-slaw; mushrooms, snow peas, snap peas, broad beans, string, wax-, or pole-beans. Include any form of the vegetable (raw, cooked, canned, or frozen). Do include tomato juice. Include culturally and geographically appropriate vegetables that are not mentioned. Do not include products consumed usually as condiments including ketchup, salsa, chutney, relish. Do not include rice or other grains.


C10 Physical Activity The next few questions are about exercise, recreation, or physical activities. 10.1A During the past week, other than your regular job, did you do any physical activities or exercise such as running, golf, swimming, yard work, or walking for exercise? 1 Yes 2 No [Go to Q10.4A] 7 Don‘t know / Not sure [Go to Q10.4A] 9 Refused [Go to Q10.4A] 10.2A (If yes): During the past week, how many times did you take part in this activity? (162-164) 1 _ _ Per week 555 Never [Go to Q10.4A] 777 Don‘t know / Not sure 999 Refused [Go to Q10.4A] 10.3A Where did you do these activities? (Code all that apply.) Please read: 1 Outside 2 In your home or friend’s home 3 At your housing clubhouse 4 At work 5 At a membership club 6 Or somewhere else (Specify.) Do not read: 7 Don‘t know / Not sure 9 Refused 10.4A During the past week, did you do physical activities or exercises to STRENGTHEN your muscles? Count activities using your own body weight like yoga, sit-ups or push-ups, or weight machines, free weights, or elastic bands. 1 Yes 2 No [Go to next section] 7 Don‘t know / Not sure [Go to next section] 9 Refused [Go to next section] 10.5A (If yes): During the past week, how many times did you take part in this activity? Please read: 1 _ _ Per week 555 Never [Go to Q11.2] 777 Don‘t know / Not sure 999 Refused [Go to Q11.2]


10.6A Where did you do these activities? (Code all that apply.) Please read: 1 Outside 2 In your home or friend’s home 3 At your housing clubhouse 4 At work 5 At a membership club 6 Or somewhere else (Specify.) Do not read: 7 Don‘t know / Not sure 9 Refused C11 Chronic Health Conditions/ Disability 11.2 Do you now have any health problem that requires you to use special equipment, such as a cane, a wheelchair, a special bed, or a special telephone? (192) NOTE: Include occasional use or use in certain circumstances. 1 Yes 2 No 7 Don‘t know / Not Sure 9 Refused 11.2A Do you or someone living with you require special in-home care? 1 Yes 2 No [Go to next section] 9 Refused [Go to next section] If 11.2A yes: 11.2B Who provides the in-home care? [single response] 1 Healthcare professional(s) 2 Friend or family members 9 Refused C15 Alcohol Consumption 15.1 During the past 30 days, how many days per week or per month did you have at least one drink of any alcoholic beverage such as beer, wine, a malt beverage or liquor? (209-211) 1 _ _ Days per week 2 _ _ Days in past 30 days 777 Don‘t know / Not sure [Go to next section] 888 No drinks in past 30 days [Go to next section] 999 Refused [Go to next section]


15.3 Considering all types of alcoholic beverages, how many times during the past 30 days did you have X [CATI X = 5 for men, X = 4 for women] or more drinks on an occasion? (214-215) _ _ Number of times 77 Don‘t know / Not sure 88 None 99 Refused Sugary Drinks SD1 How often do you drink regular soda such as Coke Classic, Pepsi, Sprite, or Mountain Dew? Do not include diet soda or seltzer. READ IF NEEDED: How many sodas do you drink per day, per week, or per month? 1 _ _ Per day 2 _ _ Per week 3 _ _ Per month 555 None / Never / Rarely 777 Don‘t know / Not sure 999 Refused SD2 How often do you drink sports drinks like Gatorade or Powerade? Do not include diet or low-calorie types. READ IF NEEDED: How many sports drinks do you drink per day, per week, or per month? 1 _ _ Per day 2 _ _ Per week 3 _ _ Per month 555 None / Never / Rarely 777 Don‘t know / Not sure 999 Refused SD3 Now think about other types of sugar sweetened drinks that are not soda or sports drinks. Some examples include fruit drinks like Snapple and cranberry juice cocktail, flavored teas and waters, and energy drinks like Red Bull and Monster. Combining all these types together, how often do you have these drinks? READ IF NEEDED: How many fruit drinks, sweetened teas and water, and energy drinks do you drink per day, per week, or per month? 1 _ _ Per day 2 _ _ Per week 3 _ _ Per month 555 None / Never / Rarely 777 Don‘t know / Not sure 999 Refused


SD4 [Ask if number of children entered in Q8.7 > 0] Thinking about your youngest child between the ages of 2 and 18, (pause in case respondent volunteers no children) how often does he or she drink regular, not diet, soda like Coke Classic, Pepsi, Sprite, or Mountain Dew? READ IF NEEDED: How many sodas does your youngest child between the ages of 2 and 18 drink per day, per week, or per month? 1 _ _ Per day 2 _ _ Per week 3 _ _ Per month 555 None / Never / Rarely 777 Don‘t know / Not sure 999 Refused SD5 [Ask if number of children entered in Q8.7] Still thinking about your youngest child between the ages of 2 and 18, how often does he or she drink sports drinks like as Gatorade or Powerade? Do not include diet or low-calorie types. READ IF NEEDED: How many sports drinks does your youngest child between the ages of 2 and 18 drink per day, per week, or per month? 1 _ _ Per day 2 _ _ Per week 3 _ _ Per month 555 None / Never / Rarely 777 Don‘t know / Not sure 999 Refused SD6 [Ask if number of children entered in Q8.7] Still thinking about your youngest child between the ages of 2 and 18, how often does he or she drink fruit drinks like cranberry juice cocktail, Capri Sun, Sunny D, Hi-C, Kool-Aid, or Hawaiian Punch? One drink would equal one pouch, box, or a small 6-ounce glass. Count a regular-sized glass as two drinks. READ IF NEEDED: How many fruit drinks does your youngest child between the ages of 2 and 18 drink per day, per week, or per month? 1 _ _ Per day 2 _ _ Per week 3 _ _ Per month 555 None / Never / Rarely 777 Don‘t know / Not sure 999 Refused SD7 In the last 30 days, have you bought any of the following types of sugar sweetened beverages for your family to drink at home? Regular soda, sports drinks like Gatorade or Powerade, fruit drinks like Capri Sun or Hawaiian Punch, energy drinks, or sweetened teas and waters? 1 Yes 2 No 7 Don‘t know / Not Sure 9 Refused


M12 Breast/ Cervical Cancer Screening CATI NOTE: If respondent is male, go to the next module. The next questions are about breast and cervical cancer screening. (Women age 40 or older): M12.1. A mammogram is an x-ray of each breast to look for breast cancer. Have you ever had a mammogram? (339) 1 Yes 2 No [Go to M12.3R] 7 Don‘t know / Not sure [Go to M12.3R] 9 Refused [Go to M12.3R] M12.2. How long has it been since you had your last mammogram? (340) Read only if necessary: (Answer categories changed from 2012.) 1 Within the past 2 years (Less than 2 years ago) 2 Between 2 and 5 years (2 years but less than 5 years ago) 3 5 or more years ago Do not read: 7 Don‘t know / Not sure 9 Refused (All women): M12.3R. A clinical breast exam is when a doctor, nurse, or other health professional feels the breasts for lumps. How long has it been since your last breast exam? (342) Read only if necessary: 1 Within the past year (anytime less than 12 months ago) 2 Within the past 2 years (1 year but less than 2 years ago) 3 Within the past 3 years (2 years but less than 3 years ago) 4 Within the past 5 years (3 years but less than 5 years ago) 5 5 or more years ago Do not read: 7 Don‘t know / Not sure 8 Have never had a clinical breast exam 9 Refused M12.5. A Pap test is a test for cancer of the cervix. Have you ever had a Pap test? (343) 1 Yes 2 No [Go to verify skip] 7 Don‘t know / Not sure [Go to verify skip] 9 Refused [Go to verify skip] M12.5A When was your last Pap test? Read only if necessary: 1 Within the past 2 years (Less than 2 years ago) 2 Between 2 and 5 years (2 years but less than 5 years ago) 3 5 or more years ago Do not read: 7 Don‘t know / Not sure 9 Refused


M14 Colorectal Cancer Screening CATI NOTE: If respondent is < 50 years of age, go to next module. M14.1. A blood stool test is a test that may use a special kit at home to determine whether the stool contains blood. Have you ever had this test using a home kit? (354) 1 Yes 2 No 7 Don't know / Not sure 9 Refused M14.3R. Sigmoidoscopy and colonoscopy are exams in which a tube is inserted in the rectum to view the colon for signs of cancer or other health problems. How long has it been since you had your last sigmoidoscopy or colonoscopy? (358) Read only if necessary: (Answer categories changed from 2012.) 1 Within the past 5 years (Less than 5 years ago) 2 Between 5 and 10 years (5 years but less than 10 years ago) 3 10 or more years ago Do not read: 7 Don‘t know / Not sure 8 Have never had a sigmoidoscopy or colonoscopy 9 Refused M16 Secondhand Smoke The next questions are about exposure to secondhand smoke. M16.2. Not counting decks, porches, or garages, during the past 7 days, that is, since last [TODAY’S DAY OF WEEK], on how many days did someone other than you smoke tobacco inside your home while you were at home? (369-370) _ _ Number of days [01-07] 8 8 None 7 7 Don‘t know / Not sure 9 9 Refused M16.3. During the past 7 days, that is, since last [TODAY’S DAY OF WEEK], on how many days did you ride in a vehicle where someone other than you was smoking tobacco? (371-372) _ _ Number of days [01-07] 8 8 None 7 7 Don‘t know / Not sure 9 9 Refused


(Ask if 8.21A=2 or 3; i.e., lives in townhouse, apartment, condo, or multi-family building; all others go to next section): M16.5A How often do you smell cigarette, cigar, or pipe tobacco smoke in your home that comes from a neighboring condo, apartment, or hallway? Please read: 1 Every day 2 Every couple of days 3 Once a week 4 Once a month 5 Never Do not read: 7 Not sure / Don’t know M26 Anxiety and Depression M26.9. Are you now taking medicine or receiving treatment from a doctor or other health professional for any type of mental health condition or emotional problem? (451) 1 Yes 2 No 7 Don‘t know / Not sure 9 Refused M28 Social Context Now, I am going to ask you about several factors that can affect a person‘s health. M28.1. How often in the past 12 months would you say you were worried or stressed about having enough money to pay vital expenses like your rent, mortgage, or food? Would you say you were worried or stressed--- (464) Please read: 1 Always 2 Usually 3 Sometimes 4 Rarely 5 Never Do not read: 8 Not applicable 7 Don‘t know / Not sure 9 Refused M28.1A During the past 12 months, was there any time when you needed mental health treatment or counseling for yourself but didn’t get it? 1 Yes 2 No [Go to next section] 7 Don‘t know / Not sure [Go to next section] 9 Refused [Go to next section]


M28.1B What was the main reason you did not get the mental health treatment and counseling you needed? Do not read: 1 Couldn’t afford it or had no insurance covering mental health care 2 Didn’t know where to get the services 3 Getting health care might cause others to think negatively about me 4 Could handle the problem myself or wouldn’t respond to treatment 5 Lack of transportation 6 Didn’t have time/Didn’t fit my schedule 8 Some other reason (Specify.) 7 Don’t know / Not sure 9 Refused 10 Scared 11 Doctor too busy 12 Laziness/Procrastination MD Oral Health LASTDEN3 MD3-1 How long has it been since you last visited a dentist or a dental clinic for any reason? Include visits to dental specialists, such as orthodontists.

1 Within the past year (anytime less than 12 months ago) 2 Within the past 2 years (1 year but less than 2 years ago) 3 Within the past 5 years (2 years but less than 5 years ago) 4 5 or more years ago Do Not Read: 7 Don’t know / Not sure 8 Never 9 Refused CATI note: If LASTDEN3= 8 (Never), go to next section. ORALCOS1 MD4-1 During the last 12 months, have you had a dental problem which you would have liked to see a dentist about but you didn’t see the dentist?

1 Yes 2 No [Go to next section] 7 Don’t know / Not sure [Go to next section] 9 Refused [Go to next section]


ORALCOS2 MD4-2 Why didn’t you see the dentist? [SINGLE RESPONSE] Please read: 1 Didn’t have time 2 It would cost too much 3 Couldn’t get an appointment 4 Would have to travel too far 5 Didn’t have a way to get there 6 Didn’t have anyone to care for my children 8 Some other reason (Specify.) Do not read: 7 Don’t know / Not sure 10 Anxiety/Don’t like dentist 11 No dental insurance 12 Didn’t think necessary/Didn’t feel like it 13 Forgot to make appointment 14 Need to find a new dentist 9 Refused [Go to next section] LYME DISEASE LD2 Are you taking any protective measures against ticks when you go outside such as wearing protective clothing, finding and removing ticks, or avoiding wooded and bushy areas? 1 Yes 2 No 7 Don’t know / Not sure ACA ACA1 As you may know, President Obama signed a health reform bill, called the Affordable Care Act, into law in 2010. How much do you know about what is in this law? Would you say you know…? Please read: 1 A lot 2 Some 3 A little 4 Not much Do not read: 7 Don’t know / Not sure 9 Refused Closing Statement Please read: That was my last question. Everyone’s answers will be combined to give us information about the health practices of people in this county. Thank you very much for your time and cooperation. Language Indicator [INTERVIEWER: DO NOT READ THIS TO RESPONDENT.] Lang1. In what language was this interview completed? 1 English 2 Spanish


Howard County General Hospital Community Health Needs ... · 30.06.2016 · The action plan...

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